Healthcare Provider Details

I. General information

NPI: 1235568338
Provider Name (Legal Business Name): KENDRA E JOHNSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 N MULLAN RD STE 2
SPOKANE VALLEY WA
99206-3857
US

IV. Provider business mailing address

626 N MULLAN RD STE 2
SPOKANE VALLEY WA
99206-3857
US

V. Phone/Fax

Practice location:
  • Phone: 509-795-2025
  • Fax: 509-984-4324
Mailing address:
  • Phone: 509-795-2025
  • Fax: 509-984-4324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP60414973
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License NumberAP6041497
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP60414973
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: