Kimenita Rosunda Johnson, INDIVIDUAL PROVIDER

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

230621 Issued in FL

Practice address

14961 Tyler St
Miami, FL 33176-7640

Phone

(786) 486-6855

Fax

(305) 688-1415

NPI assigned

Jun 18, 2008

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

Other identifiers 1

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": "1213747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1213747200000",
    "number": "1962663450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14961 TYLER ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331767640",
            "telephone_number": "786-486-6855",
            "fax_number": "305-688-1415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14961 TYLER ST",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331767640",
            "telephone_number": "786-486-6855",
            "fax_number": "305-688-1415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KIMENITA",
        "middle_name": "ROSUNDA",
        "name_prefix": "Ms.",
        "credential": "INDIVIDUAL PROVIDER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-06-18",
        "last_updated": "2008-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "FL",
            "license": "230621",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOMEMAKER &COMPANION SERVICES",
            "identifier": "230621",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathryn Johnson, RN
• Keith Johnson, MSW
• Kendelyn Janee Johnson
• Keneadra Lajill Johnson, B.S.
• Kevona Johnson
• Kyle Johnson, DPM
• Lakesha Shamora Johnson, HS
• Lashea Monet Johnson, MD
• Latrise Martell Johnson
• Lauren Lee Johnson

• Community Health Worker in Miami, FL
• Providers in Miami, FL by specialty
• Community Health Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; 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.