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NPI Code Detail

MEDICARE: KELSEY MICHELLE JOHNSON FNP-C

MEDICARE: KELSEY MICHELLE JOHNSON FNP-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
1363LX0001XObstetrics & Gynecology Nurse PractitionerRN217099GA
2363LF0000XFamily Nurse PractitionerRN217099GA

General Provider Information

NPI Number : 1700245602
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELSEY MICHELLE JOHNSON FNP-C
Provider Business Mailing Address
First Line : 865 N HIGHLAND AVE NE
Second Line :
City : ATLANTA
State : GA
Zip : 30306-4565
Country : US
Telephone Number : 404-733-6089
Fax Number :
Provider Business Practice Location Address
First Line : 865 N HIGHLAND AVE NE
Second Line :
City : ATLANTA
State : GA
Zip : 30306-4565
Country : US
Telephone Number : 404-733-6089
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2016
Last Update Date : 09/10/2020

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