Individual
BLAKE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
804 22ND AVE, KEARNEY, NE 68845-2206
(308) 455-3600
Mailing address
804 22ND AVE, KEARNEY, NE 68845-2206
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
01/16/2018
Last updated
01/16/2018
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