Healthcare Provider Details

I. General information

NPI: 1174039341
Provider Name (Legal Business Name): KELSEY E JOHNSTON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2017
Last Update Date: 01/06/2022
Certification Date: 01/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1489 S HIGLEY RD STE 101
GILBERT AZ
85296
US

IV. Provider business mailing address

655 S DOBSON RD STE 101
CHANDLER AZ
85224
US

V. Phone/Fax

Practice location:
  • Phone: 480-571-1554
  • Fax: 480-687-1802
Mailing address:
  • Phone: 480-459-2555
  • Fax: 480-687-1802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10123
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: