Provider Demographics
NPI:1902167364
Name:JOHNSON, KASSIE SOEFJE (MD)
Entity type:Individual
Prefix:DR
First Name:KASSIE
Middle Name:SOEFJE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-356-6800
Mailing Address - Fax:859-363-4073
Practice Address - Street 1:135 COURTHOUSE XING
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KY
Practice Address - Zip Code:41051-2509
Practice Address - Country:US
Practice Address - Phone:859-356-6800
Practice Address - Fax:859-363-4073
Is Sole Proprietor?:No
Enumeration Date:2012-06-01
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYTP198207Q00000X
NC2020-03203207Q00000X, 207QS0010X
TXQ1632207QS0010X
KY59606207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine