Individual
KATY FLINN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5145 SELLERS RD, SHALLOTTE, NC 28470-3405
(910) 754-4441
(910) 754-5307
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(910) 754-4441
(910) 754-5307
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-02891
NC
363A00000X
Physician Assistant
1657
SC
363A00000X
Physician Assistant
TL1657
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1191PA
—
SC
01
—
TL1657
MEDICAL LICENSE
SC
Enumeration date
06/17/2011
Last updated
06/15/2021
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