Individual
NANCY KELLY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11790 SW BARNES RD STE 140, PORTLAND, OR 97225-5938
(503) 646-0161
(503) 643-7459
Mailing address
11790 SW BARNES RD STE 140, PORTLAND, OR 97225-5938
(503) 643-2100
(503) 643-7459
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD17293
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
058474
—
OR
Enumeration date
10/05/2006
Last updated
10/21/2021
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