| NPI | 1871986331 |
|---|---|
| Former Name | TIERRA SIMONE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: GA RN216891) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner Family (Licence: GA RN216891) |
| Enumeration Date | 2015-03-09 |
| Last Update Date | 2022-01-25 |