Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 28122383 | IN |
N | 363LN0000X | Nurse Practitioner - Neonatal | 71001903 | IN |
NPI | 1083702526 |
---|---|
Provider Name | Kathryn L Johnston |
First Address | Indianapolis, IN 46206-1026 |
Second Address | Indianapolis, IN 46202-5128 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 08/07/2007 |