Robert Leroy Johnson
Technician, Attendant Care Provider in Hardy, AR. Individual provider (NPI-1).
NPI number1053945352
StatusActive
Last updated in NPPESJun 10, 2020
Details
- NPI
- 1053945352
- Entity type
- Individual (NPI-1)
- Name
- Mr. Robert Leroy Johnson
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Feb 25, 2020
- Certification date
- Jun 10, 2020
- Last updated
- Jun 10, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 3747A0650X | Technician, Attendant Care Provider | – | – | Yes |
Practice location
29 Tucker RdHardy, AR 72542-9115
Phone 870-955-0972
Mailing address
29 Tucker Rd.Hardy, AR 72542
Phone 870-955-0972
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