Provider Demographics
NPI:1780302711
Name:JOHNSON, KARRYLEE MURLINE
Entity type:Individual
Prefix:
First Name:KARRYLEE
Middle Name:MURLINE
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 1:933 CENTINELA AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90302-1501
Mailing Address - Country:US
Mailing Address - Phone:310-878-2858
Mailing Address - Fax:
Practice Address - Street 1:933 CENTINELA AVE UNIT B
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90302-1501
Practice Address - Country:US
Practice Address - Phone:310-878-2858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95021621363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily