Healthcare Provider Details

I. General information

NPI: 1265341846
Provider Name (Legal Business Name): KEVONA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1270 NE 207TH TER
MIAMI FL
33179-2021
US

IV. Provider business mailing address

3041 NW 183RD ST
MIAMI GARDENS FL
33056-3535
US

V. Phone/Fax

Practice location:
  • Phone: 305-413-2305
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: