Carolyn Jean Johnson, MD
Individual provider Active NPI Family Medicine Physician · Tsaile, AZ
NPI 1073697447 · NPPES record last updated Sep 15, 2011
Key facts
- NPI
- 1073697447
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 39380 (CO)
- Practice address
- Navajo Route 64
Tsaile, AZ 86556 - Phone
- (928) 724-3600
- Fax
- (928) 724-3605
- NPI assigned
- Oct 24, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39380 | CO | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Robert a Heyl MD PC | Family Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 39380 | CO | Yes |
Addresses
Primary practice location
Navajo Route 64
Tsaile, AZ 86556
Mailing address
PO Drawer PH
Chinle, AZ 86503
Phone (928) 674-7166
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 91086678 | Medicaid | CO |
Other providers in Tsaile, AZ
- DHHS PHS Naihs Chinle Comprehensive Health Care Facility
- Julie Elizabeth Dunston
- Rodney Leigh Jacob
- Tehnijah L Jake
- JD'S Transport Services
- James E. Manning
- Clarissa Miller
- Mountain View Home Care, LLC
- Kaitlin Richards
- Sergey Selinger
All providers in Tsaile, AZ · Family Medicine Physician in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 15, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.