Kenyatta Johnson

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

351207 Issued in NY

Practice address

254A Lake Ave
Staten Island, NY 10303-2602

Phone

(718) 502-7608

NPI assigned

Sep 25, 2024

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": "1727222400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727222400000",
    "number": "1316764863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "254A LAKE AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103032602",
            "telephone_number": "718-502-7608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "254A LAKE AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103032602",
            "telephone_number": "718-502-7608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KENYATTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-09-25",
        "last_updated": "2024-09-25",
        "certification_date": "2024-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NY",
            "license": "351207",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Austin Johnson, CRPA
• Balign Johnson
• Christine A Johnson, MS. ED.
• Eva Johnson, LPN
• Jendayi Lauvenia Johnson
• Klonette Johnson, LCSW
• Melanie Shae Johnson, OTR/L
• Nancy Johnson, LPN
• Nicolle Marie Johnson
• Shanelle Johnson

• Licensed Practical Nurse in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Licensed Practical Nurse in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2024; 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.