Provider Demographics
NPI:1821886227
Name:JOHNSON, TERRY D
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 LAFAYETTE AVE UNIT 609
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63104-3354
Mailing Address - Country:US
Mailing Address - Phone:314-202-0413
Mailing Address - Fax:
Practice Address - Street 1:1515 LAFAYETTE AVE UNIT 609
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104-3354
Practice Address - Country:US
Practice Address - Phone:314-202-0413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)