Provider Demographics
NPI:1770923294
Name:JENNIFER L. JOHNSON, MD PLLC
Entity type:Organization
Organization Name:JENNIFER L. JOHNSON, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-242-1646
Mailing Address - Street 1:PO BOX 7663
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79608-7663
Mailing Address - Country:US
Mailing Address - Phone:325-242-1646
Mailing Address - Fax:
Practice Address - Street 1:4351 RIDGEMONT DR
Practice Address - Street 2:SUITE A
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-8701
Practice Address - Country:US
Practice Address - Phone:325-698-4545
Practice Address - Fax:325-698-4547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-28
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty