Healthcare Provider Details

I. General information

NPI: 1750120739
Provider Name (Legal Business Name): NEKITA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

968 FAIRWOOD AVE
COLUMBUS OH
43206-1816
US

IV. Provider business mailing address

968 FAIRWOOD AVE
COLUMBUS OH
43206-1816
US

V. Phone/Fax

Practice location:
  • Phone: 614-441-1290
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: