MEDICARE: CHEYENNE RAI JOHNSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	MA061685	PA

General Provider Information

NPI Number	:	1023622412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHEYENNE RAI JOHNSON

Provider Business Mailing Address
First Line	:	174 KLINE RD
Second Line	:
City	:	SHIPPENSBURG
State	:	PA
Zip	:	17257-9008
Country	:	US
Telephone Number	:	814-577-1487
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 WILSON ST STE 109
Second Line	:
City	:	CARLISLE
State	:	PA
Zip	:	17013-3697
Country	:	US
Telephone Number	:	717-249-1929
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2020
Last Update Date	:	02/09/2026

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Directions to “ CHEYENNE RAI JOHNSON ” Practice Location

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