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NPI Code Detail

MEDICARE: STEPHANIE KRYSTIE JOHNSON AGNP

MEDICARE: STEPHANIE KRYSTIE JOHNSON AGNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner71014713AIN
2363LG0600XGerontology Nurse Practitioner28225777AIN

General Provider Information

NPI Number : 1043085145
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE KRYSTIE JOHNSON AGNP
Provider Business Mailing Address
First Line : PO BOX 637764
Second Line :
City : CINCINNATI
State : OH
Zip : 45263-7764
Country : US
Telephone Number : 317-880-3939
Fax Number :
Provider Business Practice Location Address
First Line : 720 ESKENAZI AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-5187
Country : US
Telephone Number : 317-880-7666
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/17/2023
Last Update Date : 12/09/2025

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