Provider Demographics
NPI:1083486963
Name:JOHNSON, ASHLEIGH KYLISHA
Entity Type:Individual
Prefix:
First Name:ASHLEIGH
Middle Name:KYLISHA
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 1:4265 CLAYTON RD APT 120
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94521-2755
Mailing Address - Country:US
Mailing Address - Phone:510-586-1480
Mailing Address - Fax:
Practice Address - Street 1:4265 CLAYTON RD APT 120
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94521-2755
Practice Address - Country:US
Practice Address - Phone:510-586-1480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-24
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider