| NPI | 1235432170 |
|---|---|
| Former Name | DEIDRA DYAN JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: OK 1937) |
| Enumeration Date | 2010-12-15 |
| Last Update Date | 2019-11-06 |