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General NPI Number Information
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NPI Number | 1407715493
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Entity Type | Individual
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Provider Name | TYNEKE JOHNSON
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Gender |
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Dates
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Enumeration Date | 01/16/2026
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Last Update Date | 01/16/2026
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Provider Practice Location Address
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Address Line | 2428 W REYNOLDS AVE
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City | CENTRALIA
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State | WA
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Zip | 98531-4554
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Country | US
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Telephone | 360-330-9044
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Fax |
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Provider Business Mailing Address
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Address Line | 21480 S 224TH PL
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City | QUEEN CREEK
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State | AZ
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Zip | 85142-2860
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Country | US
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Telephone |
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 230579
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License Number State | AZ
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