Healthcare Provider Details

I. General information

NPI: 1336838424
Provider Name (Legal Business Name): KELLY MAY JOHNSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 STEVE SMITH WAY
CROSS ROADS TX
76227-3668
US

IV. Provider business mailing address

6800 FORT PARKER WAY
MCKINNEY TX
75071-7176
US

V. Phone/Fax

Practice location:
  • Phone: 940-365-3030
  • Fax:
Mailing address:
  • Phone: 720-351-2596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1210725
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: