Stacy Nicole Johnson
Individual provider Active NPI Contractor · Wilmer, TX
NPI 1235672189 · NPPES record last updated Nov 27, 2016
Key facts
- NPI
- 1235672189
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Contractor 171W00000X
- Practice address
- 259 Green Meadows Rd
Wilmer, TX 75172-3336 - Phone
- (469) 231-4293
- NPI assigned
- Nov 27, 2016
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | Yes |
Addresses
Primary practice location
259 Green Meadows Rd
Wilmer, TX 75172-3336
Mailing address
259 Green Meadows Rd
Wilmer, TX 75172-3336
Phone (469) 231-4293
Other providers in Wilmer, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 27, 2016. 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.