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General NPI Number Information
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NPI Number | 1588967897
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Entity Type | Individual
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Provider Name | MS. PANDORA JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 12/08/2010
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Last Update Date | 07/14/2023
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Provider Practice Location Address
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Address Line | 1636 POPPS FERRY RD STE 110
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City | BILOXI
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State | MS
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Zip | 39532-2276
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Country | US
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Telephone | 228-380-2370
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Fax | 228-331-0367
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Provider Business Mailing Address
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Address Line | PO BOX 6494
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City | GULFPORT
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State | MS
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Zip | 39506-6494
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Country | US
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Telephone | 228-380-2370
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Fax | 228-331-0367
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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 | 347C00000X
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Taxonomy Name | Private Vehicle
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License Number | 347C00000X
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number | 253Z00000X
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number |
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License Number State | MS
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