MEDICARE: CORDELIA 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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1851240584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORDELIA JOHNSON

Provider Business Mailing Address
First Line	:	3415 BATAAN MEMORIAL W
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88012-5012
Country	:	US
Telephone Number	:	505-392-3482
Fax Number	:

Provider Business Practice Location Address
First Line	:	787 DUNK BLANTON RD
Second Line	:
City	:	TULLAHOMA
State	:	TN
Zip	:	37388-5925
Country	:	US
Telephone Number	:	317-409-4564
Fax Number	:

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

Provider Enumeration Date	:	01/26/2026
Last Update Date	:	01/26/2026

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Directions to “ CORDELIA JOHNSON ” Practice Location

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