Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 2016013980 | MO |
NPI | 1750737060 |
---|---|
Provider Name | Kaitlyn Johnson |
First Address | Hazelwood, MO 63042 |
Second Address | Hazelwood, MO 63042-4103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2016 |
Last Update Date | 05/05/2016 |