Healthcare Provider Details

I. General information

NPI: 1952538746
Provider Name (Legal Business Name): KATIE JOHNSON D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2009
Last Update Date: 11/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32060 LONG NECK RD
MILLSBORO DE
19966-6228
US

IV. Provider business mailing address

32060 LONG NECK RD
MILLSBORO DE
19966-6228
US

V. Phone/Fax

Practice location:
  • Phone: 214-820-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC2-0012072
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP3360
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberBP10033996
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberC2-0012072
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: