Doctor Name: | MRS. KRISTIN M JOHNSON |
NPI Number: | 1003165275 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | 28150798A |
Business Practice Address: | 1202 W Buena Vista Rd Suite 100 Evansville, IN - 477105191 |
Business Phone Number: | 8124291520 |
Business Fax Number: | 8124291523 |
Mailing Address: | 1202 W Buena Vista Rd, Suite 100 EVANSVILLE |
State: | IN |
Postal Code: | 477105191 |
Phone Number: | 8124291520 |
Fax Number: | 8124291523 |
NPI Enumeration Date: | 09/04/2012 |
NPI Last Update Date: | 09/04/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 28150798A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |