MEDICARE: KRISTEN COLES JOHNSON PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN11013659	FL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP10018	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396239224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTEN COLES JOHNSON PMHNP

Provider Business Mailing Address
First Line	:	3450 CHERRY RIDGE RD
Second Line	:
City	:	LYNN HAVEN
State	:	FL
Zip	:	32444-5640
Country	:	US
Telephone Number	:	318-355-4433
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 JENKS AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-2441
Country	:	US
Telephone Number	:	850-684-1874
Fax Number	:

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

Provider Enumeration Date	:	06/14/2018
Last Update Date	:	05/04/2026

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