Individual
CAROL P JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1000 RUSH DR, SALIDA, CO 81201-9627
(719) 530-2048
(719) 530-2055
Mailing address
550 W HWY 50, SALIDA, CO 81201-2238
(719) 530-2048
(719) 530-2055
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA765
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
431815499
—
ME
Enumeration date
02/24/2006
Last updated
01/28/2021
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