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General NPI Number Information
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NPI Number | 1073787024
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Entity Type | Individual
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Provider Name | JENNIFER LEIGH JOHNSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/21/2008
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Last Update Date | 04/20/2023
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Provider Practice Location Address
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Address Line | 4351 RIDGEMONT DR SUITE A
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City | ABILENE
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State | TX
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Zip | 79606-8701
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Country | US
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Telephone | 325-698-4545
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Fax | 325-698-4547
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Provider Business Mailing Address
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Address Line | PO BOX 7663
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City | ABILENE
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State | TX
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Zip | 79608-7663
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Country | US
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Telephone | 325-242-1646
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Fax |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | N9573
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License Number State | TX
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