| NPI | 1104323765 |
|---|---|
| Former Name | KAYLA JEAN JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0804X Psychiatry & Neurology, Child & Adolescent Psychiatry (Licence: MN 74543) |
| Additional Taxonomies | 208D00000X General Practice (Licence: WI 71836-20) |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2023-11-13 |