Individual
MARY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
120 W 16TH ST, MOUNTAIN GROVE, MO 65711-1039
(417) 926-6111
Mailing address
120 W 16TH ST, MOUNTAIN GROVE, MO 65711-1039
(417) 926-6111
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2019007175
MO
Other
Enumeration date
03/13/2019
Last updated
01/18/2022
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