Healthcare Provider Details

I. General information

NPI: 1407720584
Provider Name (Legal Business Name): KOBE JAMIR JOHNSON BSN, RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2025
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 W LOS FELIZ RD UNIT 330
GLENDALE CA
91204-3562
US

IV. Provider business mailing address

435 W LOS FELIZ RD UNIT 330
GLENDALE CA
91204-3562
US

V. Phone/Fax

Practice location:
  • Phone: 501-574-2874
  • Fax:
Mailing address:
  • Phone: 501-574-2874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number95363700
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: