Healthcare Provider Details

I. General information

NPI: 1770923294
Provider Name (Legal Business Name): JENNIFER L. JOHNSON, MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 04/20/2023
Certification Date: 04/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4351 RIDGEMONT DR SUITE A
ABILENE TX
79606-8701
US

IV. Provider business mailing address

PO BOX 7663
ABILENE TX
79608-7663
US

V. Phone/Fax

Practice location:
  • Phone: 325-698-4545
  • Fax: 325-698-4547
Mailing address:
  • Phone: 325-242-1646
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER JOHNSON
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 325-242-1646