Provider Demographics
NPI:1235568338
Name:JOHNSON, KENDRA E (ARNP)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 E 29TH AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-3961
Mailing Address - Country:US
Mailing Address - Phone:509-795-2025
Mailing Address - Fax:509-984-4324
Practice Address - Street 1:2204 E 29TH AVE STE 206
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-3961
Practice Address - Country:US
Practice Address - Phone:509-795-2025
Practice Address - Fax:509-984-4324
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60414973367A00000X, 363LW0102X
WAAP6041497202D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No202D00000XAllopathic & Osteopathic PhysiciansIntegrative Medicine