Provider Demographics
NPI:1881797702
Name:JOHNSON, NEYSA L (MD)
Entity type:Individual
Prefix:DR
First Name:NEYSA
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:305 MIRON DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-7831
Mailing Address - Country:US
Mailing Address - Phone:214-663-1172
Mailing Address - Fax:817-479-9363
Practice Address - Street 1:305 MIRON DR
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-7831
Practice Address - Country:US
Practice Address - Phone:817-479-9363
Practice Address - Fax:817-479-9363
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM07702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry