Individual
KATHRYN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
301 PROSPECT AVE, SYRACUSE, NY 13203-1807
(315) 448-5111
Mailing address
301 PROSPECT AVE, SYRACUSE, NY 13203-1807
(315) 448-5111
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
07/22/2013
Last updated
08/17/2015
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