Provider Demographics
NPI:1720787658
Name:JOHNSON, KATHERINE L (DNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 HARBOUR HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-2141
Mailing Address - Country:US
Mailing Address - Phone:301-904-8059
Mailing Address - Fax:
Practice Address - Street 1:137 MITCHELLS CHANCE RD STE 180
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-2793
Practice Address - Country:US
Practice Address - Phone:410-224-8220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR211668163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse