Healthcare Provider Details

I. General information

NPI: 1942644182
Provider Name (Legal Business Name): KRISTIN J JOHNSON M.D. IN JUNE 2013
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 8TH AVE SHMC 3 NORTH
SPOKANE WA
99204-2307
US

IV. Provider business mailing address

PO BOX 421
LIBERTY LAKE WA
99019-0421
US

V. Phone/Fax

Practice location:
  • Phone: 509-474-7500
  • Fax:
Mailing address:
  • Phone: 509-474-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD60647436
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: