Provider Demographics
NPI:1053892638
Name:JOHNSON, JENNIFER YVONNE
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:YVONNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N HERITAGE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591-9326
Mailing Address - Country:US
Mailing Address - Phone:409-789-2082
Mailing Address - Fax:
Practice Address - Street 1:121 N HERITAGE OAKS DR
Practice Address - Street 2:
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-9326
Practice Address - Country:US
Practice Address - Phone:409-789-2082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health