Healthcare Provider Details

I. General information

NPI: 1629587613
Provider Name (Legal Business Name): KATHERINE S JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2017
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 MAIN ST STE 3
NORTHAMPTON MA
01060-3127
US

IV. Provider business mailing address

8 SCHOOL ST
HATFIELD MA
01038-9770
US

V. Phone/Fax

Practice location:
  • Phone: 413-588-2077
  • Fax: 413-296-2162
Mailing address:
  • Phone: 413-588-2077
  • Fax: 413-296-2162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN2298411
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberRN2298411
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: