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NPI Code Detail

MEDICARE: MELODY B JOHNSON PA-C

MEDICARE: MELODY B JOHNSON PA-C
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
1363A00000XPhysician Assistant085012093IL
2363A00000XPhysician AssistantPA.0009681CO
3363A00000XPhysician Assistant13206MN

General Provider Information

NPI Number : 1386295954
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELODY B JOHNSON PA-C
Provider Business Mailing Address
First Line : PO BOX 211699
Second Line :
City : EAGAN
State : MN
Zip : 55121-3699
Country : US
Telephone Number : 866-849-0692
Fax Number :
Provider Business Practice Location Address
First Line : PO BOX 211699
Second Line :
City : EAGAN
State : MN
Zip : 55121-3699
Country : US
Telephone Number : 866-849-0692
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2019
Last Update Date : 02/12/2026

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Directions to “ MELODY B JOHNSON PA-C” Practice Location

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