Provider Demographics
NPI:1134887615
Name:JOHNSON, KATHLEEN ANN (CRNP)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:MISS
Other - First Name:KATHLEEN
Other - Middle Name:ANN
Other - Last Name:KERR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8000 CRANBERRY SPRINGS DR FL 1
Mailing Address - Street 2:
Mailing Address - City:CRANBERRY TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6687
Mailing Address - Country:US
Mailing Address - Phone:724-720-3098
Mailing Address - Fax:724-720-3099
Practice Address - Street 1:8000 CRANBERRY SPRINGS DR FL 1
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066-6687
Practice Address - Country:US
Practice Address - Phone:724-720-3098
Practice Address - Fax:724-720-3099
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN689230163W00000X
PASP024770363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse