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: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 MAIN ST STE 14
NORTHAMPTON MA
01060-3187
US

IV. Provider business mailing address

160 MAIN ST STE 14
NORTHAMPTON MA
01060-3187
US

V. Phone/Fax

Practice location:
  • Phone: 413-203-4134
  • Fax: 800-580-4703
Mailing address:
  • Phone: 413-203-4134
  • Fax: 800-580-4703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: