Individual
CORINE N JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
855 PROTON RD, SAN ANTONIO, TX 78258-4203
(210) 614-1234
(210) 614-0952
Mailing address
3338 OAKWELL CT STE 114, SAN ANTONIO, TX 78218-3087
(210) 268-0120
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP129216
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
354403301
—
TX
05
—
354403302
—
TX
01
—
462011YQE5
MEDICARE
TX
01
—
462011YX7W
MEDICARE
TX
Enumeration date
10/05/2015
Last updated
09/24/2020
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