MEDICARE: JOANNA KEHINDE BOGUNJOKO

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1154278273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA KEHINDE BOGUNJOKO

Provider Business Mailing Address
First Line	:	2816 HUCKLEBERRY HILL DR
Second Line	:
City	:	FORT MILL
State	:	SC
Zip	:	29715-8383
Country	:	US
Telephone Number	:	704-291-9267
Fax Number	:

Provider Business Practice Location Address
First Line	:	2938 THE PLZ
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-2463
Country	:	US
Telephone Number	:	704-291-9267
Fax Number	:

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

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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