Provider Demographics
NPI:1942540745
Name:JOHNSON, KELLEY ERIN (RN, CPNP)
Entity Type:Individual
Prefix:MRS
First Name:KELLEY
Middle Name:ERIN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN, CPNP
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Mailing Address - Street 1:621 S NEW BALLAS RD STE 693A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8263
Mailing Address - Country:US
Mailing Address - Phone:314-251-6898
Mailing Address - Fax:314-251-4197
Practice Address - Street 1:621 S NEW BALLAS RD STE 693A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8263
Practice Address - Country:US
Practice Address - Phone:314-251-6898
Practice Address - Fax:314-251-4197
Is Sole Proprietor?:No
Enumeration Date:2013-02-15
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006006547363LP0200X
MO2012041691364SP0810X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0810XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Family
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics