Individual
KELLY DENISE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
5023 E 56TH ST STE 110, INDIANAPOLIS, IN 46226-1471
(317) 565-7217
Mailing address
5216 FAWN HILL CT, INDIANAPOLIS, IN 46226-1412
(702) 323-1742
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
202202031NP
OR
363L00000X
Nurse Practitioner
Primary
71009618A
IN
363L00000X
Nurse Practitioner
818071
NV
363LF0000X
Family Nurse Practitioner
1207717
TX
363LF0000X
Family Nurse Practitioner
202202031NP
OR
363LF0000X
Family Nurse Practitioner
Primary
71009618A
IN
363LF0000X
Family Nurse Practitioner
818071
NV
Other
Enumeration date
01/29/2019
Last updated
02/23/2026
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