Provider Demographics
NPI:1427387679
Name:JOHNSON, COLLEEN M (ARNP)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:M
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7306 WYOMING ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-1259
Mailing Address - Country:US
Mailing Address - Phone:816-822-2056
Mailing Address - Fax:
Practice Address - Street 1:7306 WYOMING ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-1259
Practice Address - Country:US
Practice Address - Phone:816-822-2056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-17
Last Update Date:2011-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS44338363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health