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General NPI Number Information
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NPI Number | 1881158236
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Entity Type | Individual
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Provider Name | KELLY DENISE JOHNSON FNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/29/2019
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Last Update Date | 08/04/2025
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Provider Practice Location Address
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Address Line | 5023 E 56TH ST STE 110
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City | INDIANAPOLIS
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State | IN
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Zip | 46226-1471
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Country | US
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Telephone | 317-565-7217
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Fax |
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Provider Business Mailing Address
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Address Line | 5216 FAWN HILL CT
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City | INDIANAPOLIS
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State | IN
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Zip | 46226-1412
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Country | US
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Telephone | 702-323-1742
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Fax |
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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 | 202202031NP
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License Number State | OR
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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 | 818071
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 1207717
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71009618A
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License Number State | IN
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