Provider Demographics
NPI:1467290619
Name:JOHNSON, KALI DEVELIN (APRN)
Entity type:Individual
Prefix:
First Name:KALI
Middle Name:DEVELIN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10506B MONTGOMERY RD
Mailing Address - Street 2:STE 304
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4400
Mailing Address - Country:US
Mailing Address - Phone:513-853-9000
Mailing Address - Fax:513-624-2964
Practice Address - Street 1:10506B MONTGOMERY RD
Practice Address - Street 2:STE 304
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-4400
Practice Address - Country:US
Practice Address - Phone:513-853-9000
Practice Address - Fax:513-624-2964
Is Sole Proprietor?:No
Enumeration Date:2024-07-19
Last Update Date:2024-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0037059363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care