Provider Demographics
NPI:1770180978
Name:JOHNSON, KAREN (RPSGT)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5117 SAVANNAH PKWY
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-7509
Mailing Address - Country:US
Mailing Address - Phone:901-870-0168
Mailing Address - Fax:
Practice Address - Street 1:5117 SAVANNAH PKWY
Practice Address - Street 2:
Practice Address - City:SOUTHAVEN
Practice Address - State:MS
Practice Address - Zip Code:38672-7509
Practice Address - Country:US
Practice Address - Phone:901-870-0168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN21270246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other