Healthcare Provider Details

I. General information

NPI: 1548436645
Provider Name (Legal Business Name): CARYN JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 08/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 NE RALPH POWELL RD
LEES SUMMIT MO
64064-2361
US

IV. Provider business mailing address

2310 HOLMES ST STE 800
KANSAS CITY MO
64108-2602
US

V. Phone/Fax

Practice location:
  • Phone: 816-404-2170
  • Fax: 816-404-2748
Mailing address:
  • Phone: 816-404-8188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2019019919
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: