Provider Demographics
NPI:1801986393
Name:JOHNSON, FELICIA (MD)
Entity type:Individual
Prefix:
First Name:FELICIA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 W MAPLE AVE STE 213
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-5397
Mailing Address - Country:US
Mailing Address - Phone:479-750-2080
Mailing Address - Fax:479-750-2082
Practice Address - Street 1:601 W MAPLE AVE STE 213
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5397
Practice Address - Country:US
Practice Address - Phone:479-750-2080
Practice Address - Fax:479-750-2082
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-3699207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR149922001Medicaid
ARP00032443OtherRAILROAD MEDICARE
ARP00032442OtherRAILROAD MEDICARE
H61436Medicare UPIN
ARP00032443OtherRAILROAD MEDICARE