Provider Demographics
NPI:1033855416
Name:JOHNSON, KRISTA MARIE (CNM, APRN, CNP)
Entity type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CNM, APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 KIPLING AVE
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-4817
Mailing Address - Country:US
Mailing Address - Phone:901-343-7873
Mailing Address - Fax:
Practice Address - Street 1:5353 WAYZATA BLVD STE 510
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1340
Practice Address - Country:US
Practice Address - Phone:952-254-3557
Practice Address - Fax:952-254-3558
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13417363LP0808X
AK191560363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology