Individual
MISS MISCHELLE K JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
16515 S. 40TH ST, BLDG 9, SUITE 143, PHOENIX, AZ 85048
(480) 712-8319
(480) 712-1305
Mailing address
16515 S. 40TH ST, BLDG 9, SUITE 143, PHOENIX, AZ 85048
(480) 712-8319
(480) 712-1305
Taxonomy
Speciality
Code
Description
License number
State
146D00000X
Personal Emergency Response Attendant
2421
AZ
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
280764
LICENSE
AZ
05
—
559346
—
AZ
01
—
F08220175
AANPCB
AZ
01
—
PA61331068
LICENSE
WA
01
—
PA9116211
LICENSE
FL
Enumeration date
11/02/2006
Last updated
11/02/2022
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