MEDICARE: YETTA 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	374U00000X	Home Health Aide

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	081097943	OTHER	TX	DUNS NUMBER

General Provider Information

NPI Number	:	1114434065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YETTA JOHNSON

Provider Business Mailing Address
First Line	:	19002 DALLAS PKWY APT 1838
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75287-3160
Country	:	US
Telephone Number	:	214-931-4595
Fax Number	:

Provider Business Practice Location Address
First Line	:	19002 DALLAS PKWY APT 1838
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75287-3160
Country	:	US
Telephone Number	:	214-931-4595
Fax Number	:

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

Provider Enumeration Date	:	01/01/2018
Last Update Date	:	03/11/2021

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Directions to “ YETTA JOHNSON ” Practice Location

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