Provider Demographics
NPI:1790167856
Name:JOHNSON, KAY YETUNDE (NP)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:YETUNDE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:YISA
Other - Middle Name:ADEGUNLE
Other - Last Name:OLURINDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:4633 EGRET CT
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-2781
Mailing Address - Country:US
Mailing Address - Phone:678-549-2323
Mailing Address - Fax:
Practice Address - Street 1:3001 LUSK DR
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080
Practice Address - Country:US
Practice Address - Phone:678-309-9977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN203788363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily