Provider Demographics
NPI:1881634459
Name:JOHNSON, KERI LYNN (CRNP)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8815 GERMANTOWN AVE
Mailing Address - Street 2:SUITE 40
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-2722
Mailing Address - Country:US
Mailing Address - Phone:215-248-3100
Mailing Address - Fax:215-248-3971
Practice Address - Street 1:8815 GERMANTOWN AVE
Practice Address - Street 2:SUITE 40
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-2722
Practice Address - Country:US
Practice Address - Phone:215-248-3100
Practice Address - Fax:215-248-3971
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELH-0000229363LW0102X
PASP006775V363LX0001X
DEL1-0026503163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101526057Medicaid
PAP86873Medicare UPIN