Individual
KASSI ROSE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
10628 PARK RD, CHARLOTTE, NC 28210-8407
(704) 667-1000
Mailing address
10628 PARK RD, CHARLOTTE, NC 28210-8407
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1160862
SC
Other
Enumeration date
08/20/2019
Last updated
04/29/2024
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