Kanisha Johnson, BSN RN

Primary specialty

General Practice Registered NurseTaxonomy code 163WG0000X

License

RN256429 Issued in GA

Practice address

6737 Bill Carruth Pkwy Apt 4311
Hiram, GA 30141-3779

Phone

(770) 370-8088

NPI assigned

Dec 2, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor on Science - Nursing, Registered Nurse

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Medilab Diagnostics LLC

  • Clinic/Center
  • Hiram, GA
  • NPI 1972261436
  NPD Authorized official

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

{
    "created_epoch": "1638403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638403200000",
    "number": "1528726080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6737 BILL CARRUTH PKWY APT 4311",
            "city": "HIRAM",
            "state": "GA",
            "postal_code": "301413779",
            "telephone_number": "770-370-8088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6737 BILL CARRUTH PKWY APT 4311",
            "city": "HIRAM",
            "state": "GA",
            "postal_code": "301413779",
            "telephone_number": "770-370-8088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KANISHA",
        "credential": "BSN RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-12-02",
        "last_updated": "2021-12-02",
        "certification_date": "2021-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN256429",
            "primary": false
        },
        {
            "code": "163WG0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, General Practice",
            "state": "GA",
            "license": "RN256429",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sherley Jean Louis
• Patricia Jean-Francois, LPC
• Brittany Park Jeffers, P.A.
• Kelly Shirlette Jenkins, PC
• Claude Johnson Jr., OTA/CLT
• Kimberly Johnson, LPC
• Kwana Jones
• Clevevoya Daletrease Jordan, LPC, NCC
• Menyuan Jordan, LCSW
• Kaday Kabba-Howard, LPC

• General Practice Registered Nurse in Hiram, GA
• Providers in Hiram, GA by specialty
• General Practice Registered Nurse in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2021; 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.