Individual
CHANDRIA LYNN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 820-3890
(417) 820-3567
Mailing address
PO BOX 2580, SPRINGFIELD, MO 65801-2580
(417) 829-4620
(417) 829-4316
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
2010014079
MO
207V00000X
Obstetrics & Gynecology Physician
ME90117
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1437250750
—
MO
05
—
275400200
—
FL
01
—
431560263
TRICARE WEST
—
Enumeration date
09/26/2006
Last updated
10/03/2014
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