Provider Demographics
NPI:1174787998
Name:JOHNSON, KRISTEN J (FNP)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:KRISTEN
Other - Last Name:JONES JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:4451 PAULSEN ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405
Mailing Address - Country:US
Mailing Address - Phone:912-350-7500
Mailing Address - Fax:912-350-7735
Practice Address - Street 1:4451 PAULSEN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405
Practice Address - Country:US
Practice Address - Phone:912-350-7500
Practice Address - Fax:912-350-7735
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN077029363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA663055018BMedicaid
GAP00687387OtherRAILROAD MEDICARE
GA663055018AMedicaid
GA511I500888Medicare PIN