Individual
KELLY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
401 CASTLE CREEK RD STE 2100, ASPEN, CO 81611-1159
(970) 476-1100
(970) 479-5835
Mailing address
301 S 320TH ST, FEDERAL WAY, WA 98003-5200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
60610430
WA
363A00000X
Physician Assistant
Primary
PA.0004662
CO
Other
Enumeration date
04/24/2014
Last updated
07/22/2024
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