Healthcare Provider Details

I. General information

NPI: 1013327659
Provider Name (Legal Business Name): CIERRA JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 07/21/2022
Certification Date: 12/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 E CRAWFORD ST
SALINA KS
67401-5103
US

IV. Provider business mailing address

737 E CRAWFORD ST
SALINA KS
67401-5103
US

V. Phone/Fax

Practice location:
  • Phone: 785-827-7261
  • Fax: 785-833-5702
Mailing address:
  • Phone: 785-827-7261
  • Fax: 785-827-9079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1013327659
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: