Healthcare Provider Details

I. General information

NPI: 1053117929
Provider Name (Legal Business Name): KATELYN JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 E MORGAN RD
HAGERMAN NM
88232-9714
US

IV. Provider business mailing address

222 STATE ROAD 129 S
BATESVILLE IN
47006-7694
US

V. Phone/Fax

Practice location:
  • Phone: 888-349-9357
  • Fax:
Mailing address:
  • Phone: 812-932-7284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-400181
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: