Individual
KRISTOFER K JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
12606 E MISSION AVE, SPOKANE VALLEY, WA 99216-3421
(509) 924-6650
Mailing address
PO BOX 758701, BALTIMORE, MD 21275-8701
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
Primary
PA60049525
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA60049525
LICENSE
WA
Enumeration date
10/07/2008
Last updated
03/10/2023
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