MEDICARE: MS. RIKESHA NELTAVIA 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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1477124071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RIKESHA NELTAVIA JOHNSON

Provider Business Mailing Address
First Line	:	2009 LA PINE DR
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36618-1520
Country	:	US
Telephone Number	:	251-487-7151
Fax Number	:

Provider Business Practice Location Address
First Line	:	2009 LA PINE DR
Second Line	:
City	:	MOBILE
State	:	AL
Zip	:	36618-1520
Country	:	US
Telephone Number	:	251-487-7151
Fax Number	:

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

Provider Enumeration Date	:	07/05/2021
Last Update Date	:	07/05/2021

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