Individual
STEPHEN D JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
969 LAKELAND DR, JACKSON, MS 39216-4606
(601) 200-2000
Mailing address
813 WEDGEWOOD CT, BRANDON, MS 39047-6366
(601) 665-4355
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R863721
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02335251
—
MS
Enumeration date
12/09/2010
Last updated
04/19/2012
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