Provider Demographics
NPI:1427756758
Name:JOHNSON, KAYLEE VANESSA (RN)
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:VANESSA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:KAYLEE
Other - Middle Name:VANESSA
Other - Last Name:KEENER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2918 E WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-8724
Mailing Address - Country:US
Mailing Address - Phone:706-529-4600
Mailing Address - Fax:706-529-4633
Practice Address - Street 1:2918 E WALNUT AVE
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-8724
Practice Address - Country:US
Practice Address - Phone:706-529-4600
Practice Address - Fax:706-529-4633
Is Sole Proprietor?:No
Enumeration Date:2023-02-16
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN268389363LF0000X, 163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily