MEDICARE: KAILA E JOHNSON

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	132700000X	Dietary Manager	DI61188977	WA
2	133V00000X	Registered Dietitian	L006372	NC
3	133V00000X	Registered Dietitian	12529665-4901	UT
4	133V00000X	Registered Dietitian	86010388	CA
5	133V00000X	Registered Dietitian	ND10310	FL
6	133V00000X	Registered Dietitian	269357	KY
7	133V00000X	Registered Dietitian	2021019201	MO
8	133V00000X	Registered Dietitian	10213181	OR
9	133V00000X	Registered Dietitian	DI61188977	WA
10	133V00000X	Registered Dietitian	39024-DI-3	NV

General Provider Information

NPI Number	:	1821456930
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAILA E JOHNSON

Provider Business Mailing Address
First Line	:	3041 E FLAMINGO RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7446
Country	:	US
Telephone Number	:	239-284-3220
Fax Number	:

Provider Business Practice Location Address
First Line	:	3041 E FLAMINGO RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7446
Country	:	US
Telephone Number	:	239-284-3220
Fax Number	:

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

Provider Enumeration Date	:	02/03/2016
Last Update Date	:	02/10/2023

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Directions to “ KAILA E JOHNSON ” Practice Location

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