Individual
MARY ANN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CFNP
Contact information
Practice address
1883 HIGHWAY 43 S, SUITE E, CANTON, MS 39046-8405
(601) 407-1137
(601) 407-1137
Mailing address
PO BOX 283, CANTON, MS 39046-0283
(601) 405-4399
(601) 405-4399
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R688916
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00124595
—
MS
Enumeration date
10/31/2006
Last updated
11/07/2012
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