Provider Demographics
NPI:1265679583
Name:JOHNSON, KATHLEEN MARGARET (ADULT NP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARGARET
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ADULT NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1009 WINDCROSS CT
Mailing Address - Street 2:STE 101
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-2678
Mailing Address - Country:US
Mailing Address - Phone:615-224-5438
Mailing Address - Fax:
Practice Address - Street 1:300 MERIDIAN CENTRE BLVD
Practice Address - Street 2:STE 320
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3981
Practice Address - Country:US
Practice Address - Phone:518-482-7663
Practice Address - Fax:585-463-3105
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF305016-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health