Healthcare Provider Details

I. General information

NPI: 1326995903
Provider Name (Legal Business Name): MERIDIAN JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 03/12/2026
Certification Date: 03/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 CAMINO DE MONTE REY UNIT A
SANTA FE NM
87505-3977
US

IV. Provider business mailing address

1851 CAMINO LA CANADA
SANTA FE NM
87501-2333
US

V. Phone/Fax

Practice location:
  • Phone: 505-697-0140
  • Fax:
Mailing address:
  • Phone: 505-697-0140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number6877
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: