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General NPI Number Information
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NPI Number | 1538636121
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Entity Type | Individual
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Provider Name | KYLEE DEE JOHNSON APRN, CNM, WHNP
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Gender | Female
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Dates
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Enumeration Date | 11/01/2018
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Last Update Date | 10/19/2025
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Provider Practice Location Address
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Address Line | 2065 E 17TH ST STE A
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City | IDAHO FALLS
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State | ID
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Zip | 83404-8042
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Country | US
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Telephone | 208-201-8265
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Fax |
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Provider Business Mailing Address
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Address Line | 2065 E 17TH ST STE A
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City | IDAHO FALLS
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State | ID
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Zip | 83404-8042
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Country | US
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Telephone | 208-497-0541
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Fax | 208-497-0873
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | 59832
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2371485
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License Number State | ID
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