MEDICARE: ASHLEY MYRIAH JOHNSON D.O.

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	2084P0800X	Psychiatry Physician	M1280	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265546618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY MYRIAH JOHNSON D.O.

Provider Business Mailing Address
First Line	:	PO BOX 12447
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76110-8447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6913 CAMP BOWIE BLVD STE 171
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-7165
Country	:	US
Telephone Number	:	817-433-5000
Fax Number	:

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	10/31/2024

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