Individual
KELLIE DIANN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1412 15TH ST, HUNTSVILLE, TX 77340-4430
(936) 222-0788
Mailing address
1412 15TH ST, HUNTSVILLE, TX 77340-4430
(936) 222-0788
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
221883
TX
Other
Enumeration date
10/05/2010
Last updated
10/05/2010
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