Healthcare Provider Details

I. General information

NPI: 1033500822
Provider Name (Legal Business Name): KIARA LYNN JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIARA LYNN HAMILTON

II. Dates (important events)

Enumeration Date: 02/15/2015
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERKINS SQ
AKRON OH
44308-1063
US

IV. Provider business mailing address

1 PERKINS SQ
AKRON OH
44308-1063
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-8530
  • Fax: 330-543-3731
Mailing address:
  • Phone: 330-543-8530
  • Fax: 330-543-3731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN 361269-COA 16978
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-16978
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.16978
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: