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General NPI Number Information
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NPI Number | 1588286942
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Entity Type | Individual
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Provider Name | EBONY JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 05/08/2020
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Last Update Date | 03/26/2021
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Provider Practice Location Address
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Address Line | 1000 W 101ST TER
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City | KANSAS CITY
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State | MO
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Zip | 64114-4556
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Country | US
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Telephone | 832-737-8777
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 140202
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City | KANSAS CITY
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State | MO
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Zip | 64114-0202
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Country | US
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Telephone | 816-803-6162
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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