Provider Demographics
NPI:1255783122
Name:KAMPF, KELLY JOHNSON (MS, MPH, CGC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:JOHNSON
Last Name:KAMPF
Suffix:
Gender:F
Credentials:MS, MPH, CGC
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:AMANDA
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, MPH
Mailing Address - Street 1:16415 ADDISON RD STE 500
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3237
Mailing Address - Country:US
Mailing Address - Phone:301-758-8924
Mailing Address - Fax:
Practice Address - Street 1:16415 ADDISON RD STE 500
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3237
Practice Address - Country:US
Practice Address - Phone:301-758-8924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS