Provider Demographics
NPI:1104142645
Name:JOHNSON, MARIE R (PA-C)
Entity type:Individual
Prefix:MRS
First Name:MARIE
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 U.S. HIGHWAY 82 WEST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7069
Mailing Address - Country:US
Mailing Address - Phone:903-870-2840
Mailing Address - Fax:903-870-2601
Practice Address - Street 1:1810 U.S. HIGHWAY 82 W
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092-7069
Practice Address - Country:US
Practice Address - Phone:903-870-2840
Practice Address - Fax:903-870-2601
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00844363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical