Provider Demographics
NPI:1730631607
Name:JOHNSON, VICTORIA ADRIENNE (PA)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:ADRIENNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1035 BELLEVUE AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1843
Mailing Address - Country:US
Mailing Address - Phone:314-925-4773
Mailing Address - Fax:
Practice Address - Street 1:11133 DUNN RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6163
Practice Address - Country:US
Practice Address - Phone:314-747-3581
Practice Address - Fax:314-747-1710
Is Sole Proprietor?:No
Enumeration Date:2016-10-26
Last Update Date:2021-08-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2016028639363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant