Individual
KIMBERLY DIANA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
1402 E COUNTY LINE RD, SUITE 2400, INDIANAPOLIS, IN 46227-0963
(317) 887-7660
Mailing address
6626 E 75TH STREET, SUITE 500, INDIANAPOLIS, IN 46250-2890
(317) 887-7880
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71005062A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201244940
—
IN
01
—
P01424369
MEDICARE RAILROAD PTAN
IN
Enumeration date
08/18/2014
Last updated
10/04/2021
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