Healthcare Provider Details

I. General information

NPI: 1700197829
Provider Name (Legal Business Name): KIMBERLY DAWN JOHNSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2010
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 BROADWAY BLVD
KANSAS CITY MO
64111-3315
US

IV. Provider business mailing address

4440 BROADWAY BLVD
KANSAS CITY MO
64111-3315
US

V. Phone/Fax

Practice location:
  • Phone: 813-531-0930
  • Fax: 816-753-2671
Mailing address:
  • Phone: 813-531-0930
  • Fax: 816-753-2671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number7443
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: