Provider Demographics
NPI:1700424413
Name:JOHNSON, KELBY (FNP)
Entity type:Individual
Prefix:
First Name:KELBY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:HASKELL
Mailing Address - State:TX
Mailing Address - Zip Code:79521-5435
Mailing Address - Country:US
Mailing Address - Phone:940-228-0612
Mailing Address - Fax:940-228-4161
Practice Address - Street 1:1417 N 1ST ST
Practice Address - Street 2:
Practice Address - City:HASKELL
Practice Address - State:TX
Practice Address - Zip Code:79521-5435
Practice Address - Country:US
Practice Address - Phone:940-228-0612
Practice Address - Fax:940-228-4161
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2025-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144346363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner