Provider Demographics
NPI:1538660097
Name:JOHNSON, KAREN JEAN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:JEAN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 N 10TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2357
Mailing Address - Country:US
Mailing Address - Phone:406-532-9101
Mailing Address - Fax:406-363-4498
Practice Address - Street 1:209 N 10TH ST STE A
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-2357
Practice Address - Country:US
Practice Address - Phone:406-532-9101
Practice Address - Fax:406-363-4498
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN23620163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health