MEDICARE: KATHERYN NELSON JOHNSTON

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	374J00000X	Doula

General Provider Information

NPI Number	:	1215646401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERYN NELSON JOHNSTON

Provider Business Mailing Address
First Line	:	1107 SMITH ST
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23510-3127
Country	:	US
Telephone Number	:	757-739-3032
Fax Number	:

Provider Business Practice Location Address
First Line	:	1107 SMITH ST
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23510-3127
Country	:	US
Telephone Number	:	757-739-3032
Fax Number	:

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

Provider Enumeration Date	:	11/16/2022
Last Update Date	:	11/16/2022

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