Healthcare Provider Details

I. General information

NPI: 1821471822
Provider Name (Legal Business Name): KARA J. JOHNSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARA J. OPP

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 DUFF AVE
AMES IA
50010-5400
US

IV. Provider business mailing address

1215 DUFF AVE PO BOX 3014
AMES IA
50010-5400
US

V. Phone/Fax

Practice location:
  • Phone: 515-239-4475
  • Fax: 515-239-4722
Mailing address:
  • Phone: 515-239-4475
  • Fax: 515-239-4722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number078937
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: