Provider Demographics
NPI:1245900505
Name:KILEA L JOHNSON FNP, P.A.
Entity type:Organization
Organization Name:KILEA L JOHNSON FNP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KILEA
Authorized Official - Middle Name:LANAY
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, FNP-C
Authorized Official - Phone:254-485-2786
Mailing Address - Street 1:7425 GLENEAGLES DR
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-8983
Mailing Address - Country:US
Mailing Address - Phone:254-485-2786
Mailing Address - Fax:817-758-0449
Practice Address - Street 1:7425 GLENEAGLES DR
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-8983
Practice Address - Country:US
Practice Address - Phone:254-485-2786
Practice Address - Fax:817-758-0449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-17
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty