Individual
KELLY JOHANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
650 MARYVILLE UNIVERSITY DR, SAINT LOUIS, MO 63141-5849
(800) 627-9855
Mailing address
1304 FRANKLIN AVE, NORMAL, IL 61761-3558
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
209.027053
IL
Other
Enumeration date
08/14/2023
Last updated
08/14/2023
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