Individual
KELLI RENEE JOHNSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
CPM, LM, EMT
Contact information
Practice address
802 FISHER RD, WINTER SPRINGS, FL 32708-3642
(407) 699-4207
(407) 699-7897
Mailing address
802 FISHER RD, WINTER SPRINGS, FL 32708-3642
(407) 699-4207
(407) 699-7897
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
MW162
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
744426
AETNA PROVIDER NUMBER
FL
01
—
Y041K
BCBS PROVIDER NO
FL
Enumeration date
05/08/2006
Last updated
07/09/2007
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