Individual
MISS STEPHANIE L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
855 MONTGOMERY ST, FORT WORTH, TX 76107-2553
(817) 735-2228
(817) 735-5089
Mailing address
800 DOVER PARK TRAIL, MANSFIELD, TX 76063
(682) 518-0013
(817) 735-5089
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
734662
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07697
PRESCRIPTIVE AUTHORITY
TX
Enumeration date
07/06/2007
Last updated
07/08/2007
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