Individual
TARA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
137 FARNSWORTH BLVD, SOLDOTNA, AK 99669-7601
(907) 262-0430
(907) 262-0431
Mailing address
43335 KALIFORNSKY BEACH RD STE 36, SOLDOTNA, AK 99669-8280
(907) 262-6331
(907) 260-4892
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
1018485
AK
171M00000X
Case Manager/Care Coordinator
—
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407224793
—
AK
05
—
1427356781
—
AK
05
—
CMG675
—
AK
Enumeration date
03/09/2011
Last updated
03/01/2019
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