Healthcare Provider Details

I. General information

NPI: 1942973854
Provider Name (Legal Business Name): KIMBERLY BRYANNA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY BRYANNA BENSON

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 N WALNUT ST
MECHANICSBURG PA
17055-3379
US

IV. Provider business mailing address

407 N WALNUT ST
MECHANICSBURG PA
17055-3379
US

V. Phone/Fax

Practice location:
  • Phone: 717-315-9956
  • Fax:
Mailing address:
  • Phone: 717-315-9956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024189162
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704410672
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP022934
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: