Healthcare Provider Details

I. General information

NPI: 1205716347
Provider Name (Legal Business Name): MYRAKLE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 WALNUT ST
COSHOCTON OH
43812-1655
US

IV. Provider business mailing address

610 WALNUT ST
COSHOCTON OH
43812-1655
US

V. Phone/Fax

Practice location:
  • Phone: 740-622-0033
  • Fax:
Mailing address:
  • Phone: 740-622-0033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: