Provider Demographics
NPI:1558962456
Name:JOHNSON, KEARA RONA' (DNP APRN FNP-BC)
Entity Type:Individual
Prefix:
First Name:KEARA
Middle Name:RONA'
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DNP APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2775 N STATE HIGHWAY 360 APT 1021
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-7810
Mailing Address - Country:US
Mailing Address - Phone:316-516-4631
Mailing Address - Fax:
Practice Address - Street 1:2775 N STATE HIGHWAY 360 APT 1021
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-7810
Practice Address - Country:US
Practice Address - Phone:316-516-4631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1018658364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health