Allysa Kylee Johnson, LPN

Individual provider Active NPI Licensed Practical Nurse · Corry, PA

NPI 1962048264 · NPPES record last updated Nov 21, 2019

Key facts

NPI
1962048264
Entity type
Individual (NPI type 1)
Primary specialty
Licensed Practical Nurse 164W00000X
License
337007 (NY)
Practice address
221 1/2 Mott St
Corry, PA 16407-1540
Phone
(716) 489-6602
NPI assigned
Nov 21, 2019
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
337007NYMDLicensed Practical Nurse

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Licensed Practical Nurse 164W00000X 337007 NY Yes

Addresses

Primary practice location

221 1/2 Mott St
Corry, PA 16407-1540

Mailing address

221 1/2 Mott St
Corry, PA 16407-1540
Phone (716) 489-6602

Other providers in Corry, PA

All providers in Corry, PA · Licensed Practical Nurse in Pennsylvania

Sources for this page

Verify at the official NPI Registry.