Healthcare Provider Details

I. General information

NPI: 1821456930
Provider Name (Legal Business Name): KAILA E JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3041 E FLAMINGO RD
LAS VEGAS NV
89121-7446
US

IV. Provider business mailing address

3041 E FLAMINGO RD
LAS VEGAS NV
89121-7446
US

V. Phone/Fax

Practice location:
  • Phone: 239-284-3220
  • Fax:
Mailing address:
  • Phone: 239-284-3220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code132700000X
TaxonomyDietary Manager
License NumberDI61188977
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL006372
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number12529665-4901
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86010388
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberND10310
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number269357
License Number StateKY
# 7
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2021019201
License Number StateMO
# 8
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number10213181
License Number StateOR
# 9
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDI61188977
License Number StateWA
# 10
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number39024-DI-3
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: