Provider Demographics
NPI:1215416516
Name:JOHNSON, KIMBERELY DAWN (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERELY
Middle Name:DAWN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 GA HIGHWAY 93 N
Mailing Address - Street 2:
Mailing Address - City:CAIRO
Mailing Address - State:GA
Mailing Address - Zip Code:39827-5729
Mailing Address - Country:US
Mailing Address - Phone:229-225-7238
Mailing Address - Fax:229-377-0832
Practice Address - Street 1:827 GA HIGHWAY 93 N
Practice Address - Street 2:
Practice Address - City:CAIRO
Practice Address - State:GA
Practice Address - Zip Code:39827-5729
Practice Address - Country:US
Practice Address - Phone:229-225-7238
Practice Address - Fax:229-377-0832
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN168872363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily