Individual
DR. TYLER KENNETH JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
200 MULLINS DR, LEBANON, OR 97355-3983
(541) 259-0235
Mailing address
101 BODIN CIR, FAIRFIELD, CA 94535-1809
(707) 423-3000
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/02/2023
Last updated
06/18/2025
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