Healthcare Provider Details

I. General information

NPI: 1689597064
Provider Name (Legal Business Name): KYLE JOHNSON EMT-P
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 GEORGIA ST
LOUISIANA MO
63353-2559
US

IV. Provider business mailing address

3148 DUQUETTE DR
SAINT CHARLES MO
63301-0614
US

V. Phone/Fax

Practice location:
  • Phone: 573-754-5531
  • Fax:
Mailing address:
  • Phone: 314-757-5583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberP-17848
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: