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Individual

KELLEY E JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
5855 BREMO RD, SUITE 102, RICHMOND, VA 23226-1930
(804) 673-2814
(804) 673-2873
Mailing address
5855 BREMO RD, SUITE 102, RICHMOND, VA 23226-1930
(804) 673-2814
(804) 673-2873

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024171014
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
C06778
GROUP PTAN
VA
Enumeration date
09/10/2013
Last updated
02/27/2015
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