Kimberly Kay Johnson, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PS015034 Issued in PA

Practice address

8431 Germantown Ave
Side Entrance
Philadelphia, PA 19118-3301

Phone

(215) 870-4416

NPI assigned

Sep 5, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347408000000",
    "number": "1164771283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8431 GERMANTOWN AVE",
            "address_2": "SIDE ENTRANCE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191183301",
            "telephone_number": "215-870-4416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8431 GERMANTOWN AVE",
            "address_2": "SIDE ENTRANCE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191183301",
            "telephone_number": "215-870-4416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KIMBERLY",
        "middle_name": "KAY",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-09-05",
        "last_updated": "2012-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PA",
            "license": "PS015034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth L Johnson III, LSW
• Keonna D'Wyette Johnson, M.D.
• Keri Lynn Johnson, CRNP
• Khalida Johnson, LPN
• Khayree Johnson
• Kirsten Johnson
• Kristin Waugh Johnson, DPT
• Kyana Johnson
• Laila Johnson
• Latisha Johnson, CRNA

• Clinical Psychologist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Clinical Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.