Provider Demographics
NPI:1023099298
Name:JOHNSON, KRISTI A (MD)
Entity type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTI
Other - Middle Name:A
Other - Last Name:NIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:28063 STATE ROUTE 62
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:OH
Mailing Address - Zip Code:44609-9608
Mailing Address - Country:US
Mailing Address - Phone:440-328-7340
Mailing Address - Fax:
Practice Address - Street 1:2376 SOUTHEAST BLVD STE B
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460
Practice Address - Country:US
Practice Address - Phone:330-965-0909
Practice Address - Fax:330-965-0897
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-079419207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2236342Medicaid
H051810Medicare PIN
OHH35495Medicare UPIN
OH160058047Medicare ID - Type UnspecifiedRAILROAD MEDICARE
OH2236342Medicaid