MEDICARE: KAREN M JOHNSON NP

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	363LP0200X	Pediatric Nurse Practitioner	0017139582	VA
2	363LP0200X	Pediatric Nurse Practitioner	0024168378	VA
3	363LP0200X	Pediatric Nurse Practitioner	13989	CA

General Provider Information

NPI Number	:	1053369868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN M JOHNSON NP

Provider Business Mailing Address
First Line	:	2139 HAYCOCK RD
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22043-1715
Country	:	US
Telephone Number	:	508-446-0564
Fax Number	:

Provider Business Practice Location Address
First Line	:	6355 WALKER LN STE 401
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22310-3250
Country	:	US
Telephone Number	:	703-924-9301
Fax Number	:

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	12/29/2021

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