Individual
SHEARREN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4293 KINSEY DR, TYLER, TX 75703-1004
(903) 592-5670
(903) 363-9207
Mailing address
306 E YOUNG ST, LONGVIEW, TX 75602-1114
(903) 241-2233
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
AP143436
TX
363L00000X
Nurse Practitioner
Primary
AP143436
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
143436
STATE LICENSE
TX
Enumeration date
10/10/2019
Last updated
06/08/2021
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