Provider Demographics
NPI:1982999397
Name:JOHNSON, ASHLEY KERYN (DNP, RN, ANP-C)
Entity Type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:KERYN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DNP, RN, ANP-C
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:KERYN
Other - Last Name:MCCABE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, ANP
Mailing Address - Street 1:10432 QUEBEC AVE S
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55438-2137
Mailing Address - Country:US
Mailing Address - Phone:480-221-3321
Mailing Address - Fax:
Practice Address - Street 1:909 FULTON ST SE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-4800
Practice Address - Country:US
Practice Address - Phone:612-676-5008
Practice Address - Fax:612-676-5024
Is Sole Proprietor?:No
Enumeration Date:2011-06-14
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4095363LA2200X
MNR160709-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health