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General NPI Number Information
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NPI Number | 1841952124
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Entity Type | Individual
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Provider Name | MISS NIKIA NICOLE JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 10/13/2021
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Last Update Date | 10/13/2021
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Provider Practice Location Address
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Address Line | 2103 BARIAL AVE
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City | PASCAGOULA
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State | MS
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Zip | 39567-3405
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Country | US
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Telephone | 251-648-5727
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Fax | 228-471-5182
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Provider Business Mailing Address
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Address Line | 2103 BARIAL AVE
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City | PASCAGOULA
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State | MS
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Zip | 39567-3405
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Country | US
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Telephone | 251-648-5727
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Fax | 228-471-5182
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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 | 6475605
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License Number State | AL
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