Individual
KELLY LAINE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
300 PASTEUR DR, STANFORD, CA 94305-2200
(650) 497-8000
Mailing address
300 PASTEUR DR, STANFORD, CA 94305-2200
(650) 497-8000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
695748
CA
363L00000X
Nurse Practitioner
Primary
19162
CA
363LA2100X
Acute Care Nurse Practitioner
19162
CA
Other
Enumeration date
10/18/2010
Last updated
03/10/2023
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