Kima Johnson, FNP
Individual provider Active NPI Nurse Practitioner · Whitehall, MI
NPI 1114959103 · NPPES record last updated Sep 10, 2015
Key facts
- NPI
- 1114959103
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 4704133105 (MI)
- Practice address
- 916 E Lewis St
Heartland Care Partners
Whitehall, MI 49461-1699 - Phone
- (419) 252-6018
- Fax
- (800) 564-5952
- NPI assigned
- Jul 7, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| JK133105 | MI | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | JK133105 | MI | |
| Nurse Practitioner | 363L00000X | 4704133105 | MI | Yes |
Addresses
Primary practice location
916 E Lewis St
Heartland Care Partners
Whitehall, MI 49461-1699
Mailing address
333 N Summit St FL 7
HCR Manorcare Medical Services of Florida LLC
Toledo, OH 43604-2615
Phone (419) 252-6018
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4338002 TYPE 11 | Medicaid | MI | |
| 500F410070 | Other | MI | BCBS |
Other providers in Whitehall, MI
- Heartland of Whitehall Mi LLC
- Gina E Houtteman
- HPCN
- HPCN
- Wayne Stewart Jackson
- Kelly'S Kare Afc
- Kellys Kare Community Life Skills LLC
- Joseph Gerard Kerschen
- Jennifer J. Koetje
- James Lynn Kolbe
All providers in Whitehall, MI · Nurse Practitioner in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 10, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.