Individual
MARY ELIZABETH KING JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1040 N MASON RD, SUITE 103, SAINT LOUIS, MO 63141-6399
(314) 469-7246
Mailing address
1352 CULPEPPER RIDGE DR, BALLWIN, MO 63021-7527
(972) 898-9221
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085003419
IL
363A00000X
Physician Assistant
2009001275
MO
Other
Enumeration date
02/13/2009
Last updated
07/21/2010
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