Individual
MRS. KELLY JARVIS JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
902965
MS
363LP0222X
Critical Care Pediatric Nurse Practitioner
Primary
902965
MS
Other
Enumeration date
10/02/2018
Last updated
10/24/2018
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