Provider Demographics
NPI:1558525329
Name:JOHNSON, KIMBERLY K
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:K
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:PO BOX 446
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:FL
Mailing Address - Zip Code:32321-0446
Mailing Address - Country:US
Mailing Address - Phone:850-643-4317
Mailing Address - Fax:850-643-5359
Practice Address - Street 1:12527 NW OLD POST RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:FL
Practice Address - Zip Code:32321-3728
Practice Address - Country:US
Practice Address - Phone:850-643-4317
Practice Address - Fax:850-643-5359
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor