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NPI Code Detail

MEDICARE: MICA K JOHNESE WHNP-BC

MEDICARE: MICA K JOHNESE WHNP-BC
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
1363LW0102XWomen's Health Nurse PractitionerAP135787TX

General Provider Information

NPI Number : 1093218299
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICA K JOHNESE WHNP-BC
Provider Business Mailing Address
First Line : 565 GRIFFITH DR
Second Line :
City : SAGINAW
State : TX
Zip : 76179-0983
Country : US
Telephone Number : 325-829-1844
Fax Number :
Provider Business Practice Location Address
First Line : 3737 GOLDMAN ST
Second Line :
City : DALLAS
State : TX
Zip : 75212-2471
Country : US
Telephone Number : 214-266-0900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2018
Last Update Date : 03/14/2018

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Directions to “ MICA K JOHNESE WHNP-BC” Practice Location

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