Provider Demographics
NPI:1407117310
Name:JOHNSON, KIMBERLY (TSHH)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:TSHH
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:TSHH
Mailing Address - Street 1:1425 PENNSYLVANIA AVE
Mailing Address - Street 2:8E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11239-2108
Mailing Address - Country:US
Mailing Address - Phone:917-415-4473
Mailing Address - Fax:718-942-0810
Practice Address - Street 1:1425 PENNSYLVANIA AVE
Practice Address - Street 2:8E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11239-2108
Practice Address - Country:US
Practice Address - Phone:917-415-4473
Practice Address - Fax:718-942-0810
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist