Healthcare Provider Details

I. General information

NPI: 1881171213
Provider Name (Legal Business Name): KARNELLA GAY JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 QUEENS CT
FROSTPROOF FL
33843-9622
US

IV. Provider business mailing address

47 QUEENS CT
FROSTPROOF FL
33843-9622
US

V. Phone/Fax

Practice location:
  • Phone: 863-528-6834
  • Fax:
Mailing address:
  • Phone: 863-528-6834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number6906956
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: