Provider Demographics
NPI:1982229027
Name:JOHNSON, LATOYA RACQUEL
Entity type:Individual
Prefix:
First Name:LATOYA
Middle Name:RACQUEL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 WATCHORN ST APT 302
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-6906
Mailing Address - Country:US
Mailing Address - Phone:919-603-7691
Mailing Address - Fax:
Practice Address - Street 1:2009 WATCHORN ST APT 302
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27703-6906
Practice Address - Country:US
Practice Address - Phone:919-603-7691
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-15
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
TX927961163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No171400000XOther Service ProvidersHealth & Wellness Coach