Provider Demographics
NPI:1073892386
Name:JOHNSON, KELI P
Entity Type:Individual
Prefix:
First Name:KELI
Middle Name:P
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2564 SALTAIR MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:OH
Mailing Address - Zip Code:45106-7803
Mailing Address - Country:US
Mailing Address - Phone:513-208-3592
Mailing Address - Fax:
Practice Address - Street 1:2564 SALTAIR MAPLE RD
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:OH
Practice Address - Zip Code:45106-7803
Practice Address - Country:US
Practice Address - Phone:513-208-3592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH400702131207376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide