Provider Demographics
NPI:1417609603
Name:JOHNSON, KASEY LEE (NP-C)
Entity Type:Individual
Prefix:
First Name:KASEY
Middle Name:LEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28504-8800
Mailing Address - Country:US
Mailing Address - Phone:252-523-0026
Mailing Address - Fax:
Practice Address - Street 1:744 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-8800
Practice Address - Country:US
Practice Address - Phone:252-523-0026
Practice Address - Fax:252-523-1855
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC269107363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily