MEDICARE: MRS. VALERIE KRISTIN 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	374U00000X	Home Health Aide
2	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1194441469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VALERIE KRISTIN JOHNSON

Provider Business Mailing Address
First Line	:	131 DAVIS FARM RD
Second Line	:
City	:	HINTON
State	:	WV
Zip	:	25951-7035
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 BERO AVE
Second Line	:
City	:	BECKLEY
State	:	WV
Zip	:	25801-6742
Country	:	US
Telephone Number	:	304-255-0620
Fax Number	:

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

Provider Enumeration Date	:	10/18/2022
Last Update Date	:	10/23/2023

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