Provider Demographics
NPI:1548640493
Name:JOHNSON, KAYLA M (MD)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:HOISINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67544-1706
Mailing Address - Country:US
Mailing Address - Phone:620-653-5067
Mailing Address - Fax:620-653-5070
Practice Address - Street 1:252 W 9TH ST STE A
Practice Address - Street 2:
Practice Address - City:HOISINGTON
Practice Address - State:KS
Practice Address - Zip Code:67544-1700
Practice Address - Country:US
Practice Address - Phone:620-653-2386
Practice Address - Fax:620-653-4186
Is Sole Proprietor?:No
Enumeration Date:2015-06-05
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-41084208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201203720AMedicaid