Provider Demographics
NPI:1740448802
Name:OWENS, JOHNNIE MAE (CNA CHILD CARE CREDE)
Entity type:Individual
Prefix:MRS
First Name:JOHNNIE
Middle Name:MAE
Last Name:OWENS
Suffix:
Gender:F
Credentials:CNA CHILD CARE CREDE
Other - Prefix:MRS
Other - First Name:JOHNNIE
Other - Middle Name:MAE
Other - Last Name:IRBY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:801 E NORTHSIDE DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-3663
Mailing Address - Country:US
Mailing Address - Phone:601-906-1024
Mailing Address - Fax:
Practice Address - Street 1:801 E NORTHSIDE DR
Practice Address - Street 2:SUITE D
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-3663
Practice Address - Country:US
Practice Address - Phone:601-906-1024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter