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General NPI Number Information
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NPI Number | 1952961567
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Entity Type | Individual
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Provider Name | KEVIN MICHAEL JOHNSON FNP
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Gender | Male
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Dates
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Enumeration Date | 06/17/2019
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Last Update Date | 11/12/2019
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Provider Practice Location Address
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Address Line | 18341 US HIGHWAY 41
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City | LANSE
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State | MI
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Zip | 49946-8024
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Country | US
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Telephone | 906-524-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 47307 LARSON RD
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City | ATLANTIC MINE
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State | MI
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Zip | 49905-9203
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Country | US
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Telephone | 906-281-2186
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F06190459
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License Number State | MI
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