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NPI Code Detail

MEDICARE: PAETYN JOHNSON

MEDICARE: PAETYN 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
1106E00000XAssistant Behavior Analyst7313TX

General Provider Information

NPI Number : 1841912003
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAETYN JOHNSON
Provider Business Mailing Address
First Line : 5751 KROGER DR STE 141
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-5633
Country : US
Telephone Number : 940-441-3550
Fax Number :
Provider Business Practice Location Address
First Line : 5751 KROGER DR STE 141
Second Line :
City : FORT WORTH
State : TX
Zip : 76244-5633
Country : US
Telephone Number : 940-441-3550
Fax Number : 940-448-3200
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2022
Last Update Date : 08/12/2024

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Directions to “ PAETYN JOHNSON ” Practice Location

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