Individual
ETHAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1235 E CHEROKEE ST, SPRINGFIELD, MO 65804-2203
(417) 496-0724
Mailing address
1123 E MEADOWLARK ST, SPRINGFIELD, MO 65810-2961
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
02/02/2026
Last updated
02/02/2026
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