Individual
MS. SHANNON VICTORIA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
WHNP
Contact information
Practice address
210 HOSPITAL CIR, CHOCTAW, MS 39350-6781
(601) 389-4420
Mailing address
193 STEWART RD, CARTHAGE, MS 39051-9600
(954) 599-6041
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
901996
MS
Other
Enumeration date
11/01/2017
Last updated
01/03/2019
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