Provider Demographics
NPI:1093526691
Name:JOHNSON, KRISTA JEAN (PA-C)
Entity type:Individual
Prefix:MS
First Name:KRISTA
Middle Name:JEAN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 WINDRIFT DR
Mailing Address - Street 2:
Mailing Address - City:GIBSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27249-3308
Mailing Address - Country:US
Mailing Address - Phone:623-570-0611
Mailing Address - Fax:
Practice Address - Street 1:204 WINDRIFT DR
Practice Address - Street 2:
Practice Address - City:GIBSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:27249-3308
Practice Address - Country:US
Practice Address - Phone:623-570-0611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant