Individual
KIRBY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
2700 LAFAYETTE ST, FORT WAYNE, IN 46806-1100
(260) 266-0780
(260) 266-0785
Mailing address
2700 LAFAYETTE ST, FORT WAYNE, IN 46806-1100
(260) 266-0780
(260) 266-0785
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71008076A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
71008076A
INDIANA STATE BOARD OF NURSING APN
IN
Enumeration date
06/28/2018
Last updated
09/27/2021
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