Provider Demographics
NPI:1487997037
Name:JOHNSON, KYRSTEN ANN (MD)
Entity type:Individual
Prefix:MRS
First Name:KYRSTEN
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KYRSTEN
Other - Middle Name:ANN
Other - Last Name:KELLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17705 HUTCHINS DR.
Mailing Address - Street 2:# 250
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345
Mailing Address - Country:US
Mailing Address - Phone:952-401-8300
Mailing Address - Fax:952-401-8242
Practice Address - Street 1:12000 ELM CREEK BLVD N
Practice Address - Street 2:SUITE 250
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7073
Practice Address - Country:US
Practice Address - Phone:952-401-8300
Practice Address - Fax:952-401-8242
Is Sole Proprietor?:No
Enumeration Date:2013-04-02
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN60466208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics