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General NPI Number Information
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NPI Number | 1366435166
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Entity Type | Individual
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Provider Name | CHRISTINA ANN JOHNSON PAC
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Gender | Female
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Dates
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Enumeration Date | 08/26/2005
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Last Update Date | 01/17/2019
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Provider Practice Location Address
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Address Line | 221 W MAPLE AVE
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City | FAYETTEVILLE
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State | WV
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Zip | 25840
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Country | US
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Telephone | 304-574-3960
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Fax | 304-574-2179
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Provider Business Mailing Address
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Address Line | PO BOX 337
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City | SCARBRO
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State | WV
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Zip | 25917-0337
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Country | US
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Telephone | 304-469-2905
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Fax | 304-465-5486
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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 | 00741
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License Number State | WV
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