Provider Demographics
NPI:1336197557
Name:JOHNSON, KATHRYN ANN (FNP)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 BEN BREWINGTON CT
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-6773
Mailing Address - Country:US
Mailing Address - Phone:919-736-3902
Mailing Address - Fax:
Practice Address - Street 1:2607 MEDICAL OFFICE PLACE
Practice Address - Street 2:WATCH MOBILE UNIT
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534
Practice Address - Country:US
Practice Address - Phone:919-222-4450
Practice Address - Fax:919-731-6902
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC21506363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2597733AMedicare ID - Type Unspecified
NC80005FMedicare UPIN