Provider Demographics
NPI:1720528391
Name:JOHNSON, NATONYA NAKESHIA (LVN)
Entity type:Individual
Prefix:
First Name:NATONYA
Middle Name:NAKESHIA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 460671
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75046-0671
Mailing Address - Country:US
Mailing Address - Phone:608-208-4545
Mailing Address - Fax:
Practice Address - Street 1:250 N 5TH ST APT 2111
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-6319
Practice Address - Country:US
Practice Address - Phone:608-208-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3222866314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility