Individual
MRS. JACQUELINE MICHELLE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
4321 WASHINGTON ST STE 6100, KANSAS CITY, MO 64111
(816) 932-3470
(816) 932-6888
Mailing address
901 E 104TH ST, MAILSTOP 400N, KANSAS CITY, MO 64131-4517
(816) 502-7104
(816) 932-3492
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
124618
MO
363LA2200X
Adult Health Nurse Practitioner
Primary
2017040108
MO
363LG0600X
Gerontology Nurse Practitioner
2017040108
MO
Other
Enumeration date
05/23/2018
Last updated
08/08/2018
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