MEDICARE: KRISTINE JOHNSON APRN, FNP-BC

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	8554	CT

General Provider Information

NPI Number	:	1356987887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINE JOHNSON APRN, FNP-BC

Provider Business Mailing Address
First Line	:	84 CHURCH HILL RD
Second Line	:
City	:	LEDYARD
State	:	CT
Zip	:	06339-1303
Country	:	US
Telephone Number	:	860-822-3924
Fax Number	:

Provider Business Practice Location Address
First Line	:	84 CHURCH HILL RD
Second Line	:
City	:	LEDYARD
State	:	CT
Zip	:	06339-1303
Country	:	US
Telephone Number	:	860-822-3924
Fax Number	:

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

Provider Enumeration Date	:	11/19/2019
Last Update Date	:	03/09/2026

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