Individual
KRISTIN D JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
101 E WOOD ST, SPARTANBURG, SC 29303-3040
(864) 560-6122
Mailing address
PO BOX 651602, CHARLOTTE, NC 28265-1602
(864) 560-4123
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1375 APRN
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
430062058
MEDICARE RAILROAD
SC
01
—
576007863
TRICARE
SC
05
—
AN0960
—
SC
Enumeration date
12/28/2006
Last updated
05/26/2009
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