Provider Demographics
NPI:1952957722
Name:JOHNSON, COREEN (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:COREEN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:COREEN
Other - Middle Name:
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:3525 FM 2484
Practice Address - Street 2:
Practice Address - City:SALADO
Practice Address - State:TX
Practice Address - Zip Code:76571-6169
Practice Address - Country:US
Practice Address - Phone:254-947-7500
Practice Address - Fax:254-947-7521
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-16
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142757363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX31274OtherPRESCRIPTION AUTHORIZATION NUMBER