Provider Demographics
NPI:1417632829
Name:JOHNSON, KAYLA CHRISTINE (MS)
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:CHRISTINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8081 TOWNSHIP LINE RD STE 203
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2189
Mailing Address - Country:US
Mailing Address - Phone:734-330-9969
Mailing Address - Fax:
Practice Address - Street 1:8081 TOWNSHIP LINE RD STE 203
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2189
Practice Address - Country:US
Practice Address - Phone:317-415-7741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99119066A170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS