Provider Demographics
NPI:1659771178
Name:JOHNSON, KARI BETH (RD)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:BETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9520 W PALM LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85037-4403
Mailing Address - Country:US
Mailing Address - Phone:623-583-3001
Mailing Address - Fax:623-583-3007
Practice Address - Street 1:15525 N 83RD AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-5820
Practice Address - Country:US
Practice Address - Phone:877-809-5092
Practice Address - Fax:623-505-3272
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered