Individual
DAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1201 FLEMING AVE, JONESBORO, AR 72401
(870) 933-5174
(870) 933-5235
Mailing address
1201 FLEMING AVE, JONESBORO, AR 72401
(870) 933-5174
(870) 933-5235
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
0110P
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5F374
MEDICARE GROUP #
AR
Enumeration date
07/14/2006
Last updated
07/08/2007
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