Provider Demographics
NPI:1295979854
Name:JOHNSON-OWENS, KAYSAN (DNP)
Entity type:Individual
Prefix:DR
First Name:KAYSAN
Middle Name:
Last Name:JOHNSON-OWENS
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42-A MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-3622
Mailing Address - Country:US
Mailing Address - Phone:410-702-7354
Mailing Address - Fax:443-569-6768
Practice Address - Street 1:3900 LOCH RAVEN BLVD BLDG 2
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2108
Practice Address - Country:US
Practice Address - Phone:443-401-1155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR153197363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD9240055Medicaid