Healthcare Provider Details

I. General information

NPI: 1285538702
Provider Name (Legal Business Name): KIRRA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 SHAKER BLVD STE 308
CLEVELAND OH
44104-3871
US

IV. Provider business mailing address

6702 BONNA AVE
CLEVELAND OH
44103-1522
US

V. Phone/Fax

Practice location:
  • Phone: 216-862-0022
  • Fax: 216-516-0483
Mailing address:
  • Phone: 216-710-2741
  • Fax: 216-516-0483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: