MEDICARE: DR. KIMBERLY E JOHNSON PSYD, HSPP, APIT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	20042216A	IN

General Provider Information

NPI Number	:	1629253802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIMBERLY E JOHNSON PSYD, HSPP, APIT

Provider Business Mailing Address
First Line	:	10761 CHESAPEAKE DR N
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46236-8964
Country	:	US
Telephone Number	:	317-260-8928
Fax Number	:	317-293-1241

Provider Business Practice Location Address
First Line	:	10761 CHESAPEAKE DR N
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46236-8964
Country	:	US
Telephone Number	:	317-748-4520
Fax Number	:	317-293-1241

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/07/2008
Last Update Date	:	01/22/2025

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