Provider Demographics
NPI:1063207827
Name:JOHNS, CARLY DAWN
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:DAWN
Last Name:JOHNS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:DAWN
Other - Last Name:CALLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1801 GORDON DR
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-7205
Mailing Address - Country:US
Mailing Address - Phone:919-961-3305
Mailing Address - Fax:
Practice Address - Street 1:1801 GORDON DR
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-7205
Practice Address - Country:US
Practice Address - Phone:919-961-3305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program