MEDICARE: KIMBERLY JOHNSON CRNA

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	367500000X	Certified Registered Nurse Anesthetist	9314881	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699116657
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY JOHNSON CRNA

Provider Business Mailing Address
First Line	:	3656 HAMILTON KY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-6466
Country	:	US
Telephone Number	:	561-478-3173
Fax Number	:

Provider Business Practice Location Address
First Line	:	3656 HAMILTON KY
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-6466
Country	:	US
Telephone Number	:	561-478-3173
Fax Number	:

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

Provider Enumeration Date	:	07/07/2013
Last Update Date	:	07/07/2013

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