MEDICARE: KYLEE 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

General Provider Information

NPI Number	:	1154216729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLEE JOHNSON

Provider Business Mailing Address
First Line	:	5908 TALBOTT ST
Second Line	:
City	:	GWYNN OAK
State	:	MD
Zip	:	21207-3921
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12530 FAIRWOOD PKWY STE 102-1126
Second Line	:
City	:	BOWIE
State	:	MD
Zip	:	20720-6356
Country	:	US
Telephone Number	:	410-995-8388
Fax Number	:

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

Provider Enumeration Date	:	06/12/2025
Last Update Date	:	06/12/2025

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Directions to “ KYLEE JOHNSON ” Practice Location

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