MEDICARE: SHAKIRA A. 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
1	363A00000X	Physician Assistant	PA03607	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8N7735	OTHER	TX	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932109311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAKIRA A. JOHNSON PA-C

Provider Business Mailing Address
First Line	:	PO BOX 660599
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75266-0599
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 LEMMON AVE STE 200
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75204-2201
Country	:	US
Telephone Number	:	214-266-1600
Fax Number	:	214-266-1790

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

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	03/15/2023

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