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Individual

TARA BETH JOHNSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MS, RD, LD

Contact information

Practice address
4301 WILSON STREET, REYNOLDS ARMY COMMUNITY HOSPITAL, FT SILL, OK 75303
(580) 558-2825
Mailing address
4301 WILSON STREET, REYNOLDS ARMY COMMUNITY HOSPITAL, FT SILL, OK 75303
(580) 558-2825

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
1878
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
243345
ACADEMY OF LACTATION POLICY AND PRACTICE
Enumeration date
12/22/2011
Last updated
07/02/2018
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