Healthcare Provider Details

I. General information

NPI: 1649174392
Provider Name (Legal Business Name): CHICARA JOHNSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHICARA JOHNSON-KITTREDGE RN

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9059 GARDNER LOOP RD TACOMA, WASHINGTON
FPO AA
98433
US

IV. Provider business mailing address

1507 FARINA LOOP SE
OLYMPIA WA
98513-9442
US

V. Phone/Fax

Practice location:
  • Phone: 253-312-0338
  • Fax: 253-966-6833
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN9608782
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: