Provider Demographics
NPI:1073179610
Name:JOHNSON, NATASHA
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
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 1:7211 PRESTON RD STE 4900
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3394
Mailing Address - Country:US
Mailing Address - Phone:469-303-8440
Mailing Address - Fax:469-303-0675
Practice Address - Street 1:7211 PRESTON RD STE 4900
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3394
Practice Address - Country:US
Practice Address - Phone:469-303-8440
Practice Address - Fax:469-303-0675
Is Sole Proprietor?:No
Enumeration Date:2019-05-18
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXV96312080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program