Provider Demographics
NPI:1679892616
Name:JOHNSON, KRISTIE (MSN,ARNP,PMHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:KRISTIE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSN,ARNP,PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3614
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-3614
Mailing Address - Country:US
Mailing Address - Phone:813-461-9652
Mailing Address - Fax:
Practice Address - Street 1:19204 NW US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:HIGH SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32643-8783
Practice Address - Country:US
Practice Address - Phone:813-461-9652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-28
Last Update Date:2022-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9258231363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002630501Medicaid
FLEX662ZOtherMEDICARE PTAN