Healthcare Provider Details

I. General information

NPI: 1114959103
Provider Name (Legal Business Name): KIMA JOHNSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 E LEWIS ST HEARTLAND CARE PARTNERS
WHITEHALL MI
49461-1699
US

IV. Provider business mailing address

333 N SUMMIT ST FL 7 HCR MANORCARE MEDICAL SERVICES OF FLORIDA LLC
TOLEDO OH
43604-2615
US

V. Phone/Fax

Practice location:
  • Phone: 419-252-6018
  • Fax: 800-564-5952
Mailing address:
  • Phone: 419-252-6018
  • Fax: 800-564-5952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberJK133105
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704133105
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: