Healthcare Provider Details

I. General information

NPI: 1538636121
Provider Name (Legal Business Name): KYLEE DEE JOHNSON APRN, CNM, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 10/19/2025
Certification Date: 10/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2065 E 17TH ST STE A
IDAHO FALLS ID
83404-8042
US

IV. Provider business mailing address

2065 E 17TH ST STE A
IDAHO FALLS ID
83404-8042
US

V. Phone/Fax

Practice location:
  • Phone: 208-201-8265
  • Fax:
Mailing address:
  • Phone: 208-497-0541
  • Fax: 208-497-0873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2371485
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number59832
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: