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NPI Code Detail

MEDICARE: MRS. SHIRLEY JOHNSON RN

MEDICARE: MRS. SHIRLEY 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
1163W00000XRegistered Nurse778709TX

General Provider Information

NPI Number : 1750057675
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHIRLEY JOHNSON RN
Provider Business Mailing Address
First Line : 147 E MCCORMICK ST
Second Line :
City : SHREVEPORT
State : LA
Zip : 71104-5122
Country : US
Telephone Number : 318-218-9860
Fax Number :
Provider Business Practice Location Address
First Line : 147 E MCCORMICK ST
Second Line :
City : SHREVEPORT
State : LA
Zip : 71104-5122
Country : US
Telephone Number : 318-218-9860
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2021
Last Update Date : 08/19/2021

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