Healthcare Provider Details

I. General information

NPI: 1891690780
Provider Name (Legal Business Name): KATHERINE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2735 CONTINENTAL RD
CHEYENNE WY
82009-8500
US

IV. Provider business mailing address

2735 CONTINENTAL RD
CHEYENNE WY
82009-8500
US

V. Phone/Fax

Practice location:
  • Phone: 307-286-1863
  • Fax:
Mailing address:
  • Phone: 307-286-1863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: