Provider Demographics
NPI:1942251996
Name:JOHNSON, KARA E (MD)
Entity Type:Individual
Prefix:DR
First Name:KARA
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 N WINDSONG DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-2255
Mailing Address - Country:US
Mailing Address - Phone:928-772-1505
Mailing Address - Fax:928-772-6343
Practice Address - Street 1:3200 N WINDSONG DR
Practice Address - Street 2:
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-2255
Practice Address - Country:US
Practice Address - Phone:928-772-1505
Practice Address - Fax:928-772-6343
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ29307207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ596413Medicaid
AZH39383Medicare UPIN
AZ65950Medicare ID - Type Unspecified