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Individual

KELLY A. JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
6403 MALCOLM DR, DALLAS, TX 75214-3104
(214) 914-2480
Mailing address
6403 MALCOLM DR, DALLAS, TX 75214-3104
(214) 914-2480

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
N8669
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2461803
OH
Enumeration date
06/23/2005
Last updated
03/22/2016
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