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General NPI Number Information
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NPI Number | 1487417119
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Entity Type | Individual
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Provider Name | KEITH D JOHNSON
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Gender | Male
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Dates
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Enumeration Date | 02/05/2024
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 511 W BURLESON ST
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City | MARSHALL
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State | TX
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Zip | 75670-3107
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Country | US
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Telephone | 972-365-1370
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Fax |
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Provider Business Mailing Address
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Address Line | 12400 CEDAR KNOLL DR
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City | BURLESON
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State | TX
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Zip | 76028-2774
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Country | US
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Telephone | 972-365-1370
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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 | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State | TX
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