Healthcare Provider Details

I. General information

NPI: 1467290619
Provider Name (Legal Business Name): KALI DEVELIN JOHNSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2024
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10506B MONTGOMERY RD STE 304
MONTGOMERY OH
45242-4400
US

IV. Provider business mailing address

10506B MONTGOMERY RD STE 304
MONTGOMERY OH
45242-4400
US

V. Phone/Fax

Practice location:
  • Phone: 513-853-9000
  • Fax: 513-624-2964
Mailing address:
  • Phone: 513-853-9000
  • Fax: 513-624-2964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAPRN.CNP.0037059
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: