Healthcare Provider Details

I. General information

NPI: 1326969791
Provider Name (Legal Business Name): DR. KATHERINE GRACE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 N 9TH AVE
PENSACOLA FL
32504-8721
US

IV. Provider business mailing address

7045 LONGLEAF CREEK DR
PENSACOLA FL
32526-9393
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-7000
  • Fax:
Mailing address:
  • Phone: 850-816-8011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11048699
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: