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General NPI Number Information
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NPI Number | 1578963179
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Entity Type | Individual
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Provider Name | KAYLA RENEE JOHNSON PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/02/2014
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Last Update Date | 09/20/2021
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Provider Practice Location Address
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Address Line | 755 W CARMEL DR STE 101
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City | CARMEL
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State | IN
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Zip | 46032-5875
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Country | US
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Telephone | 317-846-2396
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Fax | 317-846-1699
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Provider Business Mailing Address
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Address Line | 801 YORK ST
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City | MANITOWOC
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State | WI
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Zip | 54220-4630
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Country | US
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Telephone | 920-663-9008
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Fax | 920-684-1439
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10002926A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 02657
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License Number State | WV
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