Individual
DR. STACEY GWEN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
402 N KEENE ST, COLUMBIA, MO 65201-6986
(573) 499-6084
(573) 499-6088
Mailing address
402 N KEENE ST, COLUMBIA, MO 65201-6986
(573) 499-6084
(573) 499-6088
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
2017018527
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2500041069
MISSOURI LICENSE
MO
Enumeration date
06/15/2017
Last updated
07/21/2022
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