| Doctor Name: | KENRA EARLINE JOHNSON |
| NPI Number: | 1033506100 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-C |
| License Number: | AP5624 |
| Business Practice Address: | 14780 W. Mountain View Blvd. Suite 110 Surprise, AZ - 853747280 |
| Business Phone Number: | 6233747774 |
| Business Fax Number: | 8777965302 |
| Mailing Address: | 14780 W. Mountain View Blvd., Suite 110 SURPRISE |
| State: | AZ |
| Postal Code: | 853747280 |
| Phone Number: | 6233747774 |
| Fax Number: | |
| NPI Enumeration Date: | 04/16/2015 |
| NPI Last Update Date: | 09/09/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | AP5624 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |