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Individual

KRISTIN L JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
702 E 34TH STREET, STE 203, JOPLIN, MO 64804
(417) 623-4077
(417) 623-5171
Mailing address
PO BOX 3810, JOPLIN, MO 64803
(417) 623-4077
(417) 623-5171

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
144504
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100021980A
OK
05
100283520B
KS
01
118064
ANTHEM
MO
05
428626311
MO
Enumeration date
07/03/2006
Last updated
10/23/2007
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