MEDICARE: ANITRA JOHNSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician	K03321482	KS

General Provider Information

NPI Number	:	1053856708
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANITRA JOHNSON

Provider Business Mailing Address
First Line	:	7843 EVERETT AVE
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66112-2130
Country	:	US
Telephone Number	:	816-447-5248
Fax Number	:

Provider Business Practice Location Address
First Line	:	7843 EVERETT AVE
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66112-2130
Country	:	US
Telephone Number	:	816-447-5248
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2017
Last Update Date	:	01/04/2017

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Directions to “ ANITRA JOHNSON ” Practice Location

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