Kevin Russell Johnson, PA-C
Physician Assistant in Dallas, TX. Individual provider (NPI-1).
NPI number1194745877
StatusActive
Last updated in NPPESMar 7, 2023
Details
- NPI
- 1194745877
- Entity type
- Individual (NPI-1)
- Name
- Mr. Kevin Russell Johnson
- Credential
- PA-C
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jul 19, 2006
- Last updated
- Mar 7, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | PA04026 | TX | Yes |
Practice location
5201 Harry Hines BlvdDallas, TX 75235-7708
Phone 817-343-0431
Mailing address
5541 Goodwin AveDallas, TX 75206-6212
Phone 817-343-0431
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