Individual
DASJARAE BRIOR JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
126 W 20TH ST STE A, OWENSBORO, KY 42303-3704
(270) 370-7815
Mailing address
PO BOX 1252, OWENSBORO, KY 42302-1252
(270) 370-7815
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
J11173829
KY
Other
Enumeration date
05/19/2022
Last updated
05/19/2022
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