Individual
KYSTAL NICOLE JOHNSON-GRAHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
26 LARK LN, SHELTON, CT 06484-2621
(203) 705-8199
Mailing address
26 LARK LN, SHELTON, CT 06484-2621
(203) 705-8199
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/19/2025
Last updated
07/19/2025
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