Individual provider Active NPI

Johnisha Keitazulu

  • Home Health Agency
  • New Haven, CT
National Provider Identifier
1396636577
Registry record updated Jul 14, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Practice address
55 Oak Ridge Dr Apt 60
New Haven, CT 06513-1176
Phone
(203) 909-8564
NPI assigned
Jul 14, 2025
Last updated
Jul 14, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 14, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X NU Primary

Addresses

Primary practice location

55 Oak Ridge Dr Apt 60
New Haven, CT 06513-1176

Mailing address

55 Oak Ridge Dr Apt 60
New Haven, CT 06513-1176
Phone (203) 909-8564

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1752451200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752451200000",
    "number": "1396636577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "55 OAK RIDGE DR APT 60",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065131176",
            "telephone_number": "203-909-8564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "55 OAK RIDGE DR APT 60",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065131176",
            "telephone_number": "203-909-8564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KEITAZULU",
        "first_name": "JOHNISHA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-07-14",
        "last_updated": "2025-07-14",
        "certification_date": "2025-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2025; 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.