Provider Demographics
NPI:1083966113
Name:JOHNSON, KRISTAN LEEANN (NP-C)
Entity Type:Individual
Prefix:
First Name:KRISTAN
Middle Name:LEEANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 DESTINATION DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-7903
Mailing Address - Country:US
Mailing Address - Phone:859-248-7908
Mailing Address - Fax:
Practice Address - Street 1:571 S ALLEN RD
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:NC
Practice Address - Zip Code:28731
Practice Address - Country:US
Practice Address - Phone:828-692-6178
Practice Address - Fax:828-356-3998
Is Sole Proprietor?:No
Enumeration Date:2012-10-13
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008151363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5008151OtherNURSE PRACTIONER
NC276187OtherRN
KY7100270770Medicaid
NCMJ4290918OtherDEA