Provider Demographics
NPI:1144648874
Name:JOHNSON, KATHERINE KEEGAN (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:KEEGAN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11140 MONTGOMERY ROAD
Mailing Address - Street 2:SUITE 340
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2906
Mailing Address - Country:US
Mailing Address - Phone:513-561-7809
Mailing Address - Fax:513-272-4121
Practice Address - Street 1:11140 MONTGOMERY RD STE 2500
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45249-2309
Practice Address - Country:US
Practice Address - Phone:513-561-7809
Practice Address - Fax:513-272-4121
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.128428207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine