Healthcare Provider Details

I. General information

NPI: 1053325126
Provider Name (Legal Business Name): COURTNEY K. JOHNSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: COURTNEY A. KUEHL PA-C

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

IV. Provider business mailing address

9200 W WISCONSIN AVE
MILWAUKEE WI
53226-3522
US

V. Phone/Fax

Practice location:
  • Phone: 414-805-9160
  • Fax: 414-805-9170
Mailing address:
  • Phone: 414-805-9160
  • Fax: 414-805-9170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1583
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1583
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: