Individual
DR. KENNETH TRAVIS JOHNSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2812 HIGHWAY 28 E, PINEVILLE, LA 71360-5715
(318) 528-3355
(318) 528-3356
Mailing address
919 HIDDEN RDG, IRVING, TX 75038-3813
(469) 282-2711
(469) 282-0996
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
017148
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1356280
—
LA
Enumeration date
11/21/2005
Last updated
04/03/2017
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