Healthcare Provider Details

I. General information

NPI: 1235926007
Provider Name (Legal Business Name): KELSEY R JOHNSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COWLES ST
FAIRBANKS AK
99701-5907
US

IV. Provider business mailing address

PO BOX 73720
FAIRBANKS AK
99707-3720
US

V. Phone/Fax

Practice location:
  • Phone: 907-458-5250
  • Fax:
Mailing address:
  • Phone: 907-322-7928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number239198
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number129303
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: