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General NPI Number Information
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NPI Number | 1730419771
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Entity Type | Individual
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Provider Name | TARA LYNN JOHNSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/13/2010
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 3533 S ALAMEDA ST
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City | CORPUS CHRISTI
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State | TX
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Zip | 78411-1721
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Country | US
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Telephone | 361-694-5000
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Fax | 361-694-5000
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Provider Business Mailing Address
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Address Line | 3533 S ALAMEDA ST
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City | CORPUS CHRISTI
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State | TX
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Zip | 78411-1721
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Country | US
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Telephone | 361-694-4520
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Fax | 361-851-6867
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | E-11312
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 2080P0008X
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Taxonomy Name | Pediatric Neurodevelopmental Disabilities Physician
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License Number | V4683
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2084N0402X
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Taxonomy Name | Neurology with Special Qualifications in Child Neurology Physician
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License Number | V4683
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | MT198880
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License Number State | MD
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