Individual
DOROTHY V JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RNC,MSN,ANP
Contact information
Practice address
6303 EVANSTON AVE, RAYTOWN, MO 64133-4929
(816) 356-4325
(816) 353-5433
Mailing address
6303 EVANSTON AVE, RAYTOWN, MO 64133-4929
(816) 356-4325
(816) 353-5433
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
046946
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06215014
BCBS OF KC GRP PROVIDER #
MO
01
—
09841038
BCBS OF KC PERF PROV ID #
MO
05
—
100216210A
—
KS
05
—
100281820A
—
KS
05
—
100281820B
—
KS
05
—
427865621
—
MO
05
—
523566107
—
MO
Enumeration date
03/06/2007
Last updated
06/25/2009
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