Provider Demographics
NPI:1952993446
Name:JOHNSON, REVON YVETTE
Entity Type:Individual
Prefix:MS
First Name:REVON
Middle Name:YVETTE
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 1:2702 PAOLI PIKE APT 337
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-5162
Mailing Address - Country:US
Mailing Address - Phone:502-631-8418
Mailing Address - Fax:
Practice Address - Street 1:2702 PAOLI PIKE APT 337
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-5162
Practice Address - Country:US
Practice Address - Phone:502-631-8418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-07
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty