Provider Demographics
NPI:1578548087
Name:JOHNSON, KRISTEN (MD)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:
Other - Last Name:COFFEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2115 NORTH KANSAS AVENUE
Mailing Address - Street 2:CHILDREN & ADOLESCENT CLINIC PC
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901
Mailing Address - Country:US
Mailing Address - Phone:402-463-6828
Mailing Address - Fax:402-463-4767
Practice Address - Street 1:2115 NORTH KANSAS AVENUE
Practice Address - Street 2:CHILDREN & ADOLESCENT CLINIC PC
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901
Practice Address - Country:US
Practice Address - Phone:402-463-6828
Practice Address - Fax:402-463-4767
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20715208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47063717813Medicaid
NE06158OtherBCBS
NE06158OtherBCBS
NE47063717813Medicaid