Provider Demographics
NPI:1295523306
Name:JOHNSON, KARISSA NICOLE LOVE
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:NICOLE LOVE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3335 STATESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-9286
Mailing Address - Country:US
Mailing Address - Phone:336-489-0000
Mailing Address - Fax:
Practice Address - Street 1:3369 CLINGMAN RD
Practice Address - Street 2:
Practice Address - City:RONDA
Practice Address - State:NC
Practice Address - Zip Code:28670-8708
Practice Address - Country:US
Practice Address - Phone:336-984-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program