MEDICARE: KRIS C JOHNSON RN

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	163WX0106X	Occupational Health Registered Nurse	1096537	AL

General Provider Information

NPI Number	:	1588442727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRIS C JOHNSON RN

Provider Business Mailing Address
First Line	:	2328 POINT MALLARD DR SE
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35601-6742
Country	:	US
Telephone Number	:	256-616-2743
Fax Number	:

Provider Business Practice Location Address
First Line	:	2328 POINT MALLARD DR SE
Second Line	:
City	:	DECATUR
State	:	AL
Zip	:	35601-6742
Country	:	US
Telephone Number	:	256-616-2743
Fax Number	:	256-552-1143

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

Provider Enumeration Date	:	09/19/2023
Last Update Date	:	09/19/2023

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