Basic Information
| Provider Information | |||||||||
| NPI: | 1487794715 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | KRISTINE | ||||||||
| MiddleName: | ERICA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 602373 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282602373 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 900 HENDERSONVILLE RD STE 205 | ||||||||
| Address2: | |||||||||
| City: | ASHEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 288031753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282589635 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2007 | ||||||||
| LastUpdateDate: | 02/09/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 2014-01586 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | D66855 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | D66855 | MD | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RI0200X | 2014-01586 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 018088200 | 05 | MD | MEDICAID |