Provider Demographics
NPI:1164963849
Name:JOHNSON, KAY A (APRN)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 598
Mailing Address - Street 2:
Mailing Address - City:MAIZE
Mailing Address - State:KS
Mailing Address - Zip Code:67101-0598
Mailing Address - Country:US
Mailing Address - Phone:316-992-7900
Mailing Address - Fax:
Practice Address - Street 1:3334 N GREY MEADOW CT
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-8716
Practice Address - Country:US
Practice Address - Phone:316-992-7900
Practice Address - Fax:913-730-7624
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS77587363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner