Healthcare Provider Details

I. General information

NPI: 1548199227
Provider Name (Legal Business Name): SHAQUISHA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 NATHAN ST APT F
ELKINS WV
26241-4503
US

IV. Provider business mailing address

501 WILSON LN
ELKINS WV
26241-5216
US

V. Phone/Fax

Practice location:
  • Phone: 540-621-2415
  • Fax:
Mailing address:
  • Phone: 304-636-9326
  • Fax: 304-636-9326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: