Healthcare Provider Details

I. General information

NPI: 1851070320
Provider Name (Legal Business Name): RAMONDA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14217 CORVALLIS RD UNIT E
NORTH LITTLE ROCK AR
72113-9079
US

IV. Provider business mailing address

14217 CORVALLIS RD UNIT E
NORTH LITTLE ROCK AR
72113-9079
US

V. Phone/Fax

Practice location:
  • Phone: 501-271-8187
  • Fax:
Mailing address:
  • Phone: 501-271-8187
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberR074244
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: