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General NPI Number Information
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NPI Number | 1437250750
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Entity Type | Individual
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Provider Name | CHANDRIA LYNN JOHNSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 10/03/2014
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Provider Practice Location Address
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Address Line | 1235 E CHEROKEE ST
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City | SPRINGFIELD
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State | MO
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Zip | 65804-2203
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Country | US
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Telephone | 417-820-3890
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Fax | 417-820-3567
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Provider Business Mailing Address
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Address Line | PO BOX 2580
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City | SPRINGFIELD
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State | MO
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Zip | 65801-2580
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Country | US
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Telephone | 417-829-4620
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Fax | 417-829-4316
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME90117
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 2010014079
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License Number State | MO
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