Provider Demographics
NPI:1629587613
Name:JOHNSON, KATHERINE S
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:S
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:HATFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01038-9770
Mailing Address - Country:US
Mailing Address - Phone:413-588-2077
Mailing Address - Fax:413-296-2162
Practice Address - Street 1:160 MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3127
Practice Address - Country:US
Practice Address - Phone:413-588-2077
Practice Address - Fax:413-296-2162
Is Sole Proprietor?:No
Enumeration Date:2017-09-22
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2298411363L00000X, 364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner