Provider Demographics
NPI:1679153589
Name:JOHNSON, KENDRA (RN)
Entity Type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 E CALLE LAURELES
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-2004
Mailing Address - Country:US
Mailing Address - Phone:805-886-4196
Mailing Address - Fax:888-873-6844
Practice Address - Street 1:3970 LA COLINA RD
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93110-1563
Practice Address - Country:US
Practice Address - Phone:805-729-1593
Practice Address - Fax:888-873-6844
Is Sole Proprietor?:No
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA545665163WM0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn