Provider Demographics
NPI:1871362244
Name:JOHNSON, KATLYNN LEE (IBCLC)
Entity type:Individual
Prefix:
First Name:KATLYNN
Middle Name:LEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 PARK DR
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-5745
Mailing Address - Country:US
Mailing Address - Phone:423-617-6286
Mailing Address - Fax:
Practice Address - Street 1:146 PARK DR
Practice Address - Street 2:
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-5745
Practice Address - Country:US
Practice Address - Phone:423-737-5794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
L-314160174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN