Doctor Name: | DR. KELVIE A JOHNSON |
NPI Number: | 1023019858 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.D. |
License Number: | MD00025100 |
Business Practice Address: | 525 Lilly Rd Ne Olympia, WA - 985065101 |
Business Phone Number: | 3604937230 |
Business Fax Number: | 3604934180 |
Mailing Address: | 525 Lilly Rd Ne, OLYMPIA |
State: | WA |
Postal Code: | 985065101 |
Phone Number: | 3604937230 |
Fax Number: | 3604934180 |
NPI Enumeration Date: | 08/02/2005 |
NPI Last Update Date: | 10/22/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207QA0000X |
License Number: | MD00025100 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Family Medicine |
Taxonomy Specialization: | Adolescent Medicine |
Taxonomy Definition: | A family medicine physician with multidisciplinary training in the unique physical, psychological and social characteristics of adolescents and their health care problems and needs. |