Provider Demographics
NPI:1659668036
Name:JOHNSON, KELLY K (MHIIM,RHIA,BS,RT(VS))
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:K
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MHIIM,RHIA,BS,RT(VS)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14734 SONOMA BLVD
Mailing Address - Street 2:
Mailing Address - City:SILVERHILL
Mailing Address - State:AL
Mailing Address - Zip Code:36576-3390
Mailing Address - Country:US
Mailing Address - Phone:850-387-6682
Mailing Address - Fax:850-785-3941
Practice Address - Street 1:14734 SONOMA BLVD
Practice Address - Street 2:
Practice Address - City:SILVERHILL
Practice Address - State:AL
Practice Address - Zip Code:36576-3390
Practice Address - Country:US
Practice Address - Phone:850-387-6682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4637562085U0001X
FL2471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL463756OtherARRT
226943OtherAHIMA