Provider Demographics
NPI:1003164575
Name:JOHNSON, KAREN (PA-C)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 BRENDON WAY
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-1961
Mailing Address - Country:US
Mailing Address - Phone:317-447-4532
Mailing Address - Fax:317-981-3132
Practice Address - Street 1:55 BRENDON WAY STE 300
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-1955
Practice Address - Country:US
Practice Address - Phone:317-498-9834
Practice Address - Fax:317-981-3132
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000367A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant