Individual
KENITA K JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4101 WOOLWORTH AVE, OMAHA, NE 68105-1850
(402) 346-8800
Mailing address
10621 POPPLETON AVE, OMAHA, NE 68124-1035
(402) 397-4769
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1279
NE
Other
Enumeration date
03/12/2007
Last updated
07/08/2007
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