Individual
MR. KENNETH M JOHNSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
2480 LLEWELLYN AVE, FT MEADE, MD 20755-5800
(301) 677-8394
(301) 677-8876
Mailing address
14018 BRIARWOOD DR, LAUREL, MD 20708-1308
(301) 776-1771
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP24559
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LP24559
LICENSED PRACTICAL NURSE
MD
Enumeration date
10/28/2005
Last updated
07/08/2007
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