Provider Demographics
NPI:1831229525
Name:JOHNSON, DOROTHY V (RNC,MSN,ANP)
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:V
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RNC,MSN,ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6303 EVANSTON AVE
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-4929
Mailing Address - Country:US
Mailing Address - Phone:816-356-4325
Mailing Address - Fax:816-353-5433
Practice Address - Street 1:6303 EVANSTON AVE
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-4929
Practice Address - Country:US
Practice Address - Phone:816-356-4325
Practice Address - Fax:816-353-5433
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2009-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO046946363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100281820AMedicaid
MO523566107Medicaid
KS100281820BMedicaid
MO06215014OtherBCBS OF KC GRP PROVIDER #
KS100216210AMedicaid
MO427865621Medicaid
MO09841038OtherBCBS OF KC PERF PROV ID #