Provider Demographics
NPI:1922393651
Name:BURNS-JOHNSON, KENNITA LUVANGEE (DO)
Entity Type:Individual
Prefix:MRS
First Name:KENNITA
Middle Name:LUVANGEE
Last Name:BURNS-JOHNSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 TURNPIKE AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-1238
Mailing Address - Country:US
Mailing Address - Phone:814-205-1900
Mailing Address - Fax:814-205-1902
Practice Address - Street 1:120 N 7TH ST STE 200
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1795
Practice Address - Country:US
Practice Address - Phone:717-217-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS018355208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOS018355OtherPA LICENSE