Individual
MARY AGNES JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1400 8TH AVE, FORT WORTH, TX 76104-4110
(817) 922-7070
Mailing address
2900 WILLING AVE, FORT WORTH, TX 76110-3446
(334) 744-0554
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
834891
TX
Other
Enumeration date
05/10/2013
Last updated
05/10/2013
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