Healthcare Provider Details

I. General information

NPI: 1619466224
Provider Name (Legal Business Name): MS. KAYLA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2018
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date: 01/23/2026
Reactivation Date: 03/16/2026

III. Provider practice location address

1040 W BRISTOL RD
FLINT MI
48507-5516
US

IV. Provider business mailing address

1040 W BRISTOL RD
FLINT MI
48507-5516
US

V. Phone/Fax

Practice location:
  • Phone: 810-257-3705
  • Fax:
Mailing address:
  • Phone: 810-257-3705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number4704370692
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: