Healthcare Provider Details

I. General information

NPI: 1649903006
Provider Name (Legal Business Name): KATHRYN ANN JOHNSON APRN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHRYN ANN ANDERSON

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 E SUPERIOR ST STE 201
DULUTH MN
55802-2228
US

IV. Provider business mailing address

400 E 3RD ST
DULUTH MN
55805-1951
US

V. Phone/Fax

Practice location:
  • Phone: 218-249-3057
  • Fax:
Mailing address:
  • Phone: 218-786-8364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9274
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: