Provider Demographics
NPI:1689498172
Name:JOHNSON, KATISHKA Z
Entity type:Individual
Prefix:
First Name:KATISHKA
Middle Name:Z
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 1:7627B WILLIAMS WAY
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-1012
Mailing Address - Country:US
Mailing Address - Phone:610-714-7747
Mailing Address - Fax:
Practice Address - Street 1:7627B WILLIAMS WAY
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1012
Practice Address - Country:US
Practice Address - Phone:610-714-7747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA20804374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula