Healthcare Provider Details

I. General information

NPI: 1760901169
Provider Name (Legal Business Name): KRISTEN MARIE JOHNSON NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2017
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 OLENTANGY RIVER RD
COLUMBUS OH
43214-3908
US

IV. Provider business mailing address

5477 RAINBOW FALLS STREET
DUBLIN OH
43016
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-5000
  • Fax: 614-566-1864
Mailing address:
  • Phone: 651-398-0286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.384874
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.020880
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: