Provider Demographics
NPI:1740900240
Name:JOHNSON, ROBERT L
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 165
Mailing Address - Street 2:
Mailing Address - City:ALKOL
Mailing Address - State:WV
Mailing Address - Zip Code:25501-0165
Mailing Address - Country:US
Mailing Address - Phone:304-542-4512
Mailing Address - Fax:
Practice Address - Street 1:121 SULPHUR SPRINGS RD
Practice Address - Street 2:
Practice Address - City:ALKOL
Practice Address - State:WV
Practice Address - Zip Code:25501
Practice Address - Country:US
Practice Address - Phone:304-524-9180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-02
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide