MEDICARE: KATE JOHNSON CNP

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
1	363LF0000X	Family Nurse Practitioner	COA.14552-NP	OH

General Provider Information

NPI Number	:	1043648462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATE JOHNSON CNP

Provider Business Mailing Address
First Line	:	9120 KINGS CANYON DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28210-7676
Country	:	US
Telephone Number	:	801-272-0215
Fax Number	:

Provider Business Practice Location Address
First Line	:	7940 WILLIAMS POND LN
Second Line	:	SUITE 150
City	:	CHARLOTTE
State	:	NC
Zip	:	28277-8766
Country	:	US
Telephone Number	:	704-209-4967
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2013
Last Update Date	:	10/08/2015

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