MEDICARE: HOLLY JO JOHNSON RN

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	171M00000X	Case Manager/Care Coordinator	658374	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	658374	OTHER	TX	REGISTERED NURSE LICENSE

General Provider Information

NPI Number	:	1508096421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HOLLY JO JOHNSON RN

Provider Business Mailing Address
First Line	:	PO BOX 338
Second Line	:
City	:	HOWE
State	:	TX
Zip	:	75459-0338
Country	:	US
Telephone Number	:	903-532-1400
Fax Number	:	903-532-1401

Provider Business Practice Location Address
First Line	:	8001 S US HWY 75
Second Line	:
City	:	SHERMAN
State	:	TX
Zip	:	75090-5707
Country	:	US
Telephone Number	:	903-532-1400
Fax Number	:	903-532-1401

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

Provider Enumeration Date	:	07/27/2009
Last Update Date	:	07/28/2009

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Directions to “ HOLLY JO JOHNSON RN” Practice Location

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