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General NPI Number Information
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NPI Number | 1417707621
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Entity Type | Individual
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Provider Name | SHANTELE M JOHNSON NP
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Gender | Female
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Dates
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Enumeration Date | 03/22/2024
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Last Update Date | 03/22/2024
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Provider Practice Location Address
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Address Line | 3422 MERIDIANA PARKWAY 300
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City | ROSHARON
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State | TX
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Zip | 77583
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Country | US
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Telephone | 832-736-1343
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Fax |
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Provider Business Mailing Address
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Address Line | 9907 BEZELED CIRCLE LN
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City | ROSHARON
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State | TX
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Zip | 77583-1057
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Country | US
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Telephone | 832-754-9731
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | A01240029
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License Number State | TX
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