Provider Demographics
NPI:1093559932
Name:JOHNSON-EGESI, DEANDRA R (RN)
Entity type:Individual
Prefix:
First Name:DEANDRA
Middle Name:R
Last Name:JOHNSON-EGESI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19126 MOSSY HEDGE LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-4133
Mailing Address - Country:US
Mailing Address - Phone:832-408-0556
Mailing Address - Fax:
Practice Address - Street 1:19126 MOSSY HEDGE LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-4133
Practice Address - Country:US
Practice Address - Phone:832-408-0556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-25
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX971600163WA2000X, 163WC0400X, 163WC1600X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1600XNursing Service ProvidersRegistered NurseContinuing Education/Staff Development