Healthcare Provider Details

I. General information

NPI: 1720296916
Provider Name (Legal Business Name): KAREN ELAINE JOHNSON MA, MSN, APRN, CNP,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2007
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 KINGSTOWN RD
WAKEFIELD RI
02879-3626
US

IV. Provider business mailing address

40 TABLE ROCK RD
WAKEFIELD RI
02879-1825
US

V. Phone/Fax

Practice location:
  • Phone: 401-789-0283
  • Fax: 401-789-0314
Mailing address:
  • Phone: 401-714-8079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN18416
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCAPRN00318
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: