Provider Demographics
NPI:1720820129
Name:JOHNSON, CIERA BERRY
Entity type:Individual
Prefix:MRS
First Name:CIERA
Middle Name:BERRY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 N PALESTINE RD
Mailing Address - Street 2:
Mailing Address - City:NATCHEZ
Mailing Address - State:MS
Mailing Address - Zip Code:39120-9011
Mailing Address - Country:US
Mailing Address - Phone:601-597-7247
Mailing Address - Fax:
Practice Address - Street 1:615 HIGHWAY 61 N
Practice Address - Street 2:
Practice Address - City:NATCHEZ
Practice Address - State:MS
Practice Address - Zip Code:39120-8406
Practice Address - Country:US
Practice Address - Phone:601-597-7247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS800532430376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker