Individual
MIKAYLA LARAE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
619 19TH ST S, BIRMINGHAM, AL 35233-1900
(205) 934-4011
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35255-5310
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.2052
AL
363AM0700X
Medical Physician Assistant
PA.2052
AL
Other
Enumeration date
08/02/2021
Last updated
11/11/2024
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