Individual
MRS. KELLY JACKSON JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
510 LINCOLN DR, HERRIN, IL 62948-6334
(618) 997-6800
(618) 997-1187
Mailing address
4787 ALBEN BARKLEY DR, SUITE 103, PADUCAH, KY 42001-6789
(270) 442-9461
(270) 441-0079
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1637
KY
Other
Enumeration date
09/20/2011
Last updated
02/23/2017
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