Provider Demographics
NPI:1356133888
Name:JOHNSON, QUENA SHANTIECE (RD/LD)
Entity type:Individual
Prefix:MISS
First Name:QUENA
Middle Name:SHANTIECE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RD/LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:397 MADISON AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-3411
Mailing Address - Country:US
Mailing Address - Phone:901-314-8971
Mailing Address - Fax:
Practice Address - Street 1:397 MADISON AVE APT 201
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-3411
Practice Address - Country:US
Practice Address - Phone:901-314-8971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4484133V00000X
OK3175133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered