Healthcare Provider Details

I. General information

NPI: 1457320327
Provider Name (Legal Business Name): KRISTIN MARIAH JOHNSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 RAILWAY AVE.
THREE FORKS MT
59752
US

IV. Provider business mailing address

PO BOX 1078
THREE FORKS MT
59752-1078
US

V. Phone/Fax

Practice location:
  • Phone: 406-285-3251
  • Fax: 406-285-6742
Mailing address:
  • Phone: 406-285-3251
  • Fax: 406-285-6742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP720A
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number29346
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: