Provider Demographics
NPI:1922393651
Name:BURNS-JOHNSON, KENNITA LUVANGEE (DO)
Entity type:Individual
Prefix:MRS
First Name:KENNITA
Middle Name:LUVANGEE
Last Name:BURNS-JOHNSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:155 WELLNESS WAY
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-6702
Mailing Address - Country:US
Mailing Address - Phone:814-231-7000
Mailing Address - Fax:814-231-7098
Practice Address - Street 1:164 GREENVIEW DR STE 345
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-2106
Practice Address - Country:US
Practice Address - Phone:814-234-7599
Practice Address - Fax:814-237-2126
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS018355208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOS018355OtherPA LICENSE