Provider Demographics
NPI:1295300754
Name:JOHNSON-BARNES, KIM LEVETTE (FNP-C)
Entity type:Individual
Prefix:
First Name:KIM
Middle Name:LEVETTE
Last Name:JOHNSON-BARNES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 DOE LN
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-8166
Mailing Address - Country:US
Mailing Address - Phone:229-392-8735
Mailing Address - Fax:
Practice Address - Street 1:8 DOE LN
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31793-8166
Practice Address - Country:US
Practice Address - Phone:229-392-8735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-26
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF05210638363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily