MEDICARE: CIARA L 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	390200000X	Student in an Organized Health Care Education/Training Program		TX

General Provider Information

NPI Number	:	1205790292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CIARA L JOHNSON

Provider Business Mailing Address
First Line	:	401 N FREDERICKSBURG ST APT 1319
Second Line	:
City	:	SAN MARCOS
State	:	TX
Zip	:	78666-1750
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 N FREDERICKSBURG ST APT 1319
Second Line	:
City	:	SAN MARCOS
State	:	TX
Zip	:	78666-1750
Country	:	US
Telephone Number	:	346-546-4058
Fax Number	:

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

Provider Enumeration Date	:	12/12/2025
Last Update Date	:	12/12/2025

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Directions to “ CIARA L JOHNSON ” Practice Location

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