Provider Demographics
NPI:1821649385
Name:JOHNSON, KAYLAN LYNNETTE (LLC)
Entity Type:Individual
Prefix:
First Name:KAYLAN
Middle Name:LYNNETTE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 POPLAR AVE STE 1715
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38157-1701
Mailing Address - Country:US
Mailing Address - Phone:901-590-5590
Mailing Address - Fax:
Practice Address - Street 1:5050 POPLAR AVE STE 1715
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38157-1701
Practice Address - Country:US
Practice Address - Phone:901-590-5590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide