Provider Demographics
NPI:1023833993
Name:JOHNSON, KIMBERLY JOYCE
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:JOYCE
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 1:1693 DELIA AVENUE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-1671
Mailing Address - Country:US
Mailing Address - Phone:980-525-7534
Mailing Address - Fax:
Practice Address - Street 1:1693 DELIA AVENUE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-1671
Practice Address - Country:US
Practice Address - Phone:980-525-7534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No172V00000XOther Service ProvidersCommunity Health Worker
No172A00000XOther Service ProvidersDriver
No253Z00000XAgenciesIn Home Supportive Care