Provider Demographics
NPI:1003604422
Name:JOHNSON, KAYE MARIE-NICOLE
Entity type:Individual
Prefix:
First Name:KAYE
Middle Name:MARIE-NICOLE
Last Name:JOHNSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 POULTNEY AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-2230
Mailing Address - Country:US
Mailing Address - Phone:716-994-4745
Mailing Address - Fax:
Practice Address - Street 1:363 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:TONAWANDA
Practice Address - State:NY
Practice Address - Zip Code:14150-3962
Practice Address - Country:US
Practice Address - Phone:716-994-4745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-26
Last Update Date:2025-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY348730164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse