Provider Demographics
NPI:1104124767
Name:JOHNSON, ANGELA S (RN, CNOR, RNFA)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:S
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN, CNOR, RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 MOORES LN
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-1840
Mailing Address - Country:US
Mailing Address - Phone:903-792-6944
Mailing Address - Fax:903-792-6213
Practice Address - Street 1:2006 MOORES LN
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-1840
Practice Address - Country:US
Practice Address - Phone:903-792-6944
Practice Address - Fax:903-792-6213
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-07
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR065480163WR0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant