Provider Demographics
NPI:1306513486
Name:JOHNSON, KIERA (MSN,APRN,PMHNP)
Entity type:Individual
Prefix:
First Name:KIERA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSN,APRN,PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 94508
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87199-4508
Mailing Address - Country:US
Mailing Address - Phone:505-715-4610
Mailing Address - Fax:
Practice Address - Street 1:6 CALLE MEDICO
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4761
Practice Address - Country:US
Practice Address - Phone:505-715-4610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-25
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCS00231052363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMMJ6968309OtherCONTROLLED SUBSTANCE REGISTRATION CERTIFICATE