Individual
KYLE ALLEN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NURSE PRACTITIONER
Contact information
Practice address
30 TECHNOLOGY DR, ROCKY MOUNT, VA 24151-3008
(540) 483-0582
Mailing address
30 TECHNOLOGY DR, ROCKY MOUNT, VA 24151-3008
(540) 483-0582
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
0024185091
VA
Other
Enumeration date
09/06/2022
Last updated
09/06/2022
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