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General NPI Number Information
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NPI Number | 1003067984
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Entity Type | Individual
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Provider Name | ANNIE JOHNSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/09/2008
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Last Update Date | 12/01/2010
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Provider Practice Location Address
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Address Line | 708 E WYTHE CREEK CT STE 103
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City | KUNA
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State | ID
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Zip | 83634-5005
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Country | US
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Telephone | 208-922-5130
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Fax | 208-922-5132
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Provider Business Mailing Address
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Address Line | PO BOX 68
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City | KUNA
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State | ID
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Zip | 83634-0068
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Country | US
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Telephone | 208-922-5130
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Fax | 208-922-5132
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA-777
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License Number State | ID
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