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NPI Code Detail

MEDICARE: KELLY LYNN JOHNSON

MEDICARE: KELLY LYNN JOHNSON
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
1171M00000XCase Manager/Care CoordinatorOH

General Provider Information

NPI Number : 1578426920
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY LYNN JOHNSON
Provider Business Mailing Address
First Line : PO BOX 614
Second Line :
City : IRONTON
State : OH
Zip : 45638-0614
Country : US
Telephone Number : 740-442-7045
Fax Number : 740-442-7047
Provider Business Practice Location Address
First Line : 149 MERCY BLVD
Second Line :
City : MOUNT ORAB
State : OH
Zip : 45154-0296
Country : US
Telephone Number : 740-442-7045
Fax Number : 740-442-7047
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2025
Last Update Date : 12/03/2025

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