MEDICARE: MR. RICKIE E. JOHNSON PA

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	363A00000X	Physician Assistant	A10226	LA

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	:	1982681292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICKIE E. JOHNSON PA

Provider Business Mailing Address
First Line	:	500 BROADWAY APT C214
Second Line	:
City	:	FARMINGTON
State	:	UT
Zip	:	84025-5657
Country	:	US
Telephone Number	:	337-278-8826
Fax Number	:	801-775-6884

Provider Business Practice Location Address
First Line	:	7238 6TH ST BLDG 249
Second Line	:
City	:	HILL AIR FORCE BASE
State	:	UT
Zip	:	84056-5213
Country	:	US
Telephone Number	:	801-777-1155
Fax Number	:	801-775-6884

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

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	04/09/2018

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Directions to “ MR. RICKIE E. JOHNSON PA” Practice Location

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