Provider Demographics
NPI:1962458182
Name:JOHNSON, JUDITH M (MSN, APRN, BC)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:
Credentials:MSN, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 S 4TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5079
Mailing Address - Country:US
Mailing Address - Phone:816-845-8550
Mailing Address - Fax:816-219-6965
Practice Address - Street 1:3515 S 4TH ST
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5013
Practice Address - Country:US
Practice Address - Phone:816-845-8550
Practice Address - Fax:816-219-6965
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0050-02022363LF0000X, 363LP0808X
AZAP3355363LP0808X
KS5379196061363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ276768Medicare ID - Type Unspecified