Individual
KEVIN M JOHNSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
P.A.-C.
Contact information
Practice address
6701 AIRPORT BLVD, SUITE D-330, MOBILE, AL 36608-6705
(251) 607-9797
(251) 607-9761
Mailing address
6701 AIRPORT BLVD, SUITE D-330, MOBILE, AL 36608-6705
(251) 607-9797
(251) 607-9761
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-433
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
515-32157
BLUE CROSS BLUE SHIELD
AL
Enumeration date
06/08/2006
Last updated
07/21/2022
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