Provider Demographics
NPI:1841366242
Name:JOHNSON, REBECCA J (DPM)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 S. SANTA FE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401
Mailing Address - Country:US
Mailing Address - Phone:785-452-6211
Mailing Address - Fax:785-452-6216
Practice Address - Street 1:501 S. SANTA FE
Practice Address - Street 2:SUITE 200
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401
Practice Address - Country:US
Practice Address - Phone:785-452-6211
Practice Address - Fax:785-452-6216
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1200348213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201103650AMedicaid
KS144201Medicare PIN
KS201103650AMedicaid
KS110116121Medicare PIN
KS5962580001Medicare NSC