Provider Demographics
NPI:1821436981
Name:JOHNSON, KATHERINE JO (DVM)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:JO
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BRIARWOOD DR
Mailing Address - Street 2:APARTMENT 2
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1978
Mailing Address - Country:US
Mailing Address - Phone:208-850-3538
Mailing Address - Fax:
Practice Address - Street 1:5624 STATE ROUTE 5
Practice Address - Street 2:
Practice Address - City:HERKIMER
Practice Address - State:NY
Practice Address - Zip Code:13350-3513
Practice Address - Country:US
Practice Address - Phone:315-866-3417
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012503174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian