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Individual

KELLY JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1818 E. WINDSOR ROAD, URBANA, IL 61802-9566
(217) 255-9670
(217) 255-9724
Mailing address
PO BOX 6002, URBANA, IL 61803-6002
(217) 326-8630

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
041308882
IL

Other

Enumeration date
01/08/2013
Last updated
08/27/2013
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