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General NPI Number Information
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NPI Number | 1114059516
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Entity Type | Individual
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Provider Name | VALERIE JOHNSON PA
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Gender | Female
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 08/16/2007
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Provider Practice Location Address
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Address Line | 6450 FOLSOM DR
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City | BEAUMONT
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State | TX
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Zip | 77706-7269
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Country | US
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Telephone | 409-835-0524
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Fax | 409-923-1293
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Provider Business Mailing Address
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Address Line | 6450 FOLSOM DR
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City | BEAUMONT
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State | TX
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Zip | 77706-7269
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Country | US
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Telephone | 409-835-0524
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Fax | 409-923-1293
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA02197
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License Number State | TX
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