MEDICARE: MYRA ANNETTE JOHNSON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	533711	TX

General Provider Information

NPI Number	:	1053627281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYRA ANNETTE JOHNSON RN

Provider Business Mailing Address
First Line	:	6810 SANDY OAKS DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77050-3842
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5103 LANGLEY RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77016-2917
Country	:	US
Telephone Number	:	713-633-7444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2010
Last Update Date	:	08/25/2010

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