MEDICARE: KALEY JOHNSON PA-C

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	363A00000X	Physician Assistant	5601013614	MI

General Provider Information

NPI Number	:	1316806086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALEY JOHNSON PA-C

Provider Business Mailing Address
First Line	:	203 QUIET CT
Second Line	:
City	:	HOUGHTON LAKE
State	:	MI
Zip	:	48629-9364
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	335 E HOUGHTON AVE
Second Line	:
City	:	WEST BRANCH
State	:	MI
Zip	:	48661-1127
Country	:	US
Telephone Number	:	989-345-8120
Fax Number	:	989-345-8129

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

Provider Enumeration Date	:	01/19/2026
Last Update Date	:	01/19/2026

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Directions to “ KALEY JOHNSON PA-C” Practice Location

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