Individual
REAGAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
401 6TH AVE, MONTGOMERY, WV 25136-2116
(304) 442-5151
Mailing address
401 6TH AVE, MONTGOMERY, WV 25136-2116
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2556
WV
Other
Enumeration date
12/03/2020
Last updated
04/19/2024
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