Individual
JENNIFER NICOLE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
271 FT RICHARDSON AVE, GOODFELLOW AFB, TX 76908
(325) 654-5190
Mailing address
271 FT RICHARDSON, GOODFELLOW AFB, TX 76908
(719) 510-1580
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
3088
NM
171000000X
Military Health Care Provider
Primary
35821
CA
Other
Enumeration date
07/13/2006
Last updated
11/25/2022
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