Individual
KIERA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN,APRN,PMHNP
Contact information
Practice address
6 CALLE MEDICO, SANTA FE, NM 87505-4761
(505) 715-4610
Mailing address
PO BOX 94508, ALBUQUERQUE, NM 87199-4508
(505) 715-4610
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
CS00231052
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MJ6968309
CONTROLLED SUBSTANCE REGISTRATION CERTIFICATE
NM
Enumeration date
08/25/2021
Last updated
01/11/2022
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