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Individual

KRISTY JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
107 OMNI DR STE A, SENECA, SC 29672-9448
(864) 482-3285
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
(864) 522-8617

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
20678
SC
363LA2100X
Acute Care Nurse Practitioner
Primary
20678
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
NP4324
SC
Enumeration date
01/30/2017
Last updated
05/12/2021
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