Healthcare Provider Details

I. General information

NPI: 1811013469
Provider Name (Legal Business Name): KATHRYN JOHNSON RN,NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 CEDAR ST SUITE C
SANTA CRUZ CA
95060-4369
US

IV. Provider business mailing address

106 FAIRVIEW AVE
CAPITOLA CA
95010-3427
US

V. Phone/Fax

Practice location:
  • Phone: 831-425-3337
  • Fax: 831-466-0366
Mailing address:
  • Phone: 831-475-3951
  • Fax: 831-475-3951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number509229
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number509229
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: