Provider Demographics
NPI:1497294573
Name:JOHNSON, KATELYN RIELEY (RN)
Entity Type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:RIELEY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:KATELYN
Other - Middle Name:MICHELLE
Other - Last Name:RIELEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7055 SAMUEL MORSE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-3439
Mailing Address - Country:US
Mailing Address - Phone:202-285-5487
Mailing Address - Fax:202-403-3105
Practice Address - Street 1:7055 SAMUEL MORSE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3439
Practice Address - Country:US
Practice Address - Phone:202-285-5487
Practice Address - Fax:202-403-3105
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1024744163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse