Provider Demographics
NPI:1639870777
Name:JOHNSEN, KATHLEEN THERESE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:THERESE
Last Name:JOHNSEN
Suffix:
Gender:F
Credentials: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:AMERICAN RED CROSS, STUTTGART STATION
Mailing Address - Street 2:PANZER KASERNE, BLDG. 2948
Mailing Address - City:STUTTGART
Mailing Address - State:BADEN-WURTTEMBERG
Mailing Address - Zip Code:09107
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:U.S. ARMY HEALTH CLINIC STUTTGART
Practice Address - Street 2:UNIT 30401
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09107
Practice Address - Country:US
Practice Address - Phone:314-430-7990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA24185546363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily