=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245646728
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HEATHER HILTON JOHNSON CPM, LM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2014
-----------------------------------------------------
Last Update Date | 01/23/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10724 MERRICK RUN
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78254-2691
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-370-7727
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10724 MERRICK RUN
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78254-2691
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-370-7727
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 175M00000X
-----------------------------------------------------
Taxonomy Name | Lay Midwife
-----------------------------------------------------
License Number | 380
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 175M00000X
-----------------------------------------------------
Taxonomy Name | Lay Midwife
-----------------------------------------------------
License Number | 99499
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------