Provider Demographics
NPI:1851932404
Name:JOHNSON, KELLY CHRISTINE (APRN)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:CHRISTINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7319 STONEROCK CIR # 106
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8002
Mailing Address - Country:US
Mailing Address - Phone:407-248-9800
Mailing Address - Fax:
Practice Address - Street 1:7319 STONEROCK CIR # 106
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8002
Practice Address - Country:US
Practice Address - Phone:407-248-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-04
Last Update Date:2020-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11002883363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily