Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | VP-004675-B | PA |
NPI | 1730181637 |
---|---|
Provider Name | Kathryn A. Johnson |
First Address | Toms River, NJ 08755-3287 |
Second Address | Neptune, NJ 07753-4743 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 14/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01732802 | (05) | PA |
OTH000 | (02) | NJ |