Individual
KODY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
1604 C. NORTH MAIN ST, MOUNTAIN GROVE, MO 65704-6570
(417) 926-1713
Mailing address
PO BOX 1359, AVA, MO 65608-1359
(417) 683-5739
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2021021292
MO
Other
Enumeration date
07/15/2021
Last updated
07/15/2021
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