| NPI | 1124836374 |
|---|---|
| Former Name | KAELENE JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CT 14060) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: CT 14060) |
| Enumeration Date | 2024-12-19 |
| Last Update Date | 2025-04-08 |