| NPI | 1013056050 |
|---|---|
| Former Name | KELLY MARIE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208C00000X Colon & Rectal Surgery (Licence: NE 26792) |
| Additional Taxonomies | 208600000X Surgery (Licence: UT 7942743-1205) |
| 208600000X Surgery (Licence: NM 2005-0329) | |
| 208600000X Surgery (Licence: NE 26792) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2021-03-15 |