Individual
TUCKER BOONE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6525 FRANCE AVE S STE 200, EDINA, MN 55435-2176
(952) 927-6501
(952) 653-1433
Mailing address
6525 FRANCE AVE S STE 200, EDINA, MN 55435-2176
(952) 927-6501
(952) 653-1433
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
12064896-1206
UT
Other
Enumeration date
03/05/2018
Last updated
10/25/2021
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