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NPI Code Detail

MEDICARE: DR. TERESA K JOHNSON MD

MEDICARE: DR. TERESA K JOHNSON MD
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
1207Q00000XFamily Medicine Physician21456KS
2207Q00000XFamily Medicine PhysicianMEDS8281AK

General Provider Information

NPI Number : 1932104098
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TERESA K JOHNSON MD
Provider Business Mailing Address
First Line : 4136 BARTLETT ST
Second Line :
City : HOMER
State : AK
Zip : 99603-7001
Country : US
Telephone Number : 907-235-8586
Fax Number : 907-235-6639
Provider Business Practice Location Address
First Line : 4136 BARTLETT ST
Second Line :
City : HOMER
State : AK
Zip : 99603-7001
Country : US
Telephone Number : 907-235-8586
Fax Number : 907-235-6639
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2005
Last Update Date : 10/17/2018

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Directions to “ DR. TERESA K JOHNSON MD” Practice Location

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