| NPI | 1033456991 |
|---|---|
| Former Name | KATIE MICHELLE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: FL ARNP9353737) |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics (Licence: NC 5009467) |
| Enumeration Date | 2013-01-12 |
| Last Update Date | 2021-03-30 |