Individual
KELLY M JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
118 BRAZOS LN, KYLE, TX 78640-5289
(512) 296-4083
Mailing address
118 BRAZOS LN, KYLE, TX 78640-5289
(512) 296-4083
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
300209
TX
Other
Enumeration date
02/16/2018
Last updated
02/16/2018
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