Provider Demographics
NPI:1477124071
Name:JOHNSON, RIKESHA NELTAVIA
Entity Type:Individual
Prefix:MS
First Name:RIKESHA
Middle Name:NELTAVIA
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 1:2009 LA PINE DR
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36618-1520
Mailing Address - Country:US
Mailing Address - Phone:251-487-7151
Mailing Address - Fax:
Practice Address - Street 1:2009 LA PINE DR
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36618-1520
Practice Address - Country:US
Practice Address - Phone:251-487-7151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-05
Last Update Date:2021-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health