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Individual
KELLY LAINE JOHNSON
Active
Individual
KELLY LAINE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
695748
CA
363L00000X
Nurse Practitioner
Primary
19162
CA
363LA2100X
Acute Care Nurse Practitioner
19162
CA
Other
Enumeration date
10/18/2010
Last updated
03/10/2023
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