Individual
EVETTE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
15225 GRAND SUMMIT EXT APT 104, GRANDVIEW, MO 64030-4686
(816) 519-6211
Mailing address
15225 GRAND SUMMIT EXT APT 104, GRANDVIEW, MO 64030-4686
(816) 519-6211
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/31/2019
Last updated
01/31/2019
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