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General NPI Number Information
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NPI Number | 1689604126
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Entity Type | Individual
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Provider Name | KRISTIN L JOHNSON NP
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Gender | Female
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 10/23/2007
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Provider Practice Location Address
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Address Line | 702 E 34TH STREET STE 203
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City | JOPLIN
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State | MO
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Zip | 64804
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Country | US
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Telephone | 417-623-4077
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Fax | 417-623-5171
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Provider Business Mailing Address
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Address Line | PO BOX 3810
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City | JOPLIN
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State | MO
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Zip | 64803
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Country | US
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Telephone | 417-623-4077
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Fax | 417-623-5171
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 144504
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License Number State | MO
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