Provider Demographics
NPI:1194336628
Name:JOHNSON, ANGELA JANE (PHLEB/VENI,HOMEHEALT)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:JANE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHLEB/VENI,HOMEHEALT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 REVERE CIR APT 13
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3468
Mailing Address - Country:US
Mailing Address - Phone:731-513-0975
Mailing Address - Fax:
Practice Address - Street 1:24 REVERE CIR APT 13
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3468
Practice Address - Country:US
Practice Address - Phone:731-513-0975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374K00000X, 251E00000X, 225400000X, 251F00000X, 253Z00000X, 343900000X, 133N00000X, 146D00000X, 172A00000X, 173000000X, 174200000X
TNJMCGHISSUED202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No251F00000XAgenciesHome Infusion
No253Z00000XAgenciesIn Home Supportive Care
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No133N00000XDietary & Nutritional Service ProvidersNutritionist
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No172A00000XOther Service ProvidersDriver
No173000000XOther Service ProvidersLegal Medicine
No174200000XOther Service ProvidersMeals