Provider Demographics
NPI:1326183880
Name:JOHNSON, KATHLEEN ALMA (NP)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ALMA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:101 HEALTH CARE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62246-1159
Mailing Address - Country:US
Mailing Address - Phone:618-664-2531
Mailing Address - Fax:618-664-2553
Practice Address - Street 1:101 HEALTH CARE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:IL
Practice Address - Zip Code:62246-1159
Practice Address - Country:US
Practice Address - Phone:618-664-2531
Practice Address - Fax:618-664-2553
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209-001610363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL285910Medicare Oscar/Certification
IL143875Medicare Oscar/Certification