MEDICARE: MCKENNA E JOHNS

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669142576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCKENNA E JOHNS

Provider Business Mailing Address
First Line	:	8001 BEATY GROVE DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-1602
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3790 DAIRY RD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32904-7630
Country	:	US
Telephone Number	:	321-729-6858
Fax Number	:

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

Provider Enumeration Date	:	09/14/2021
Last Update Date	:	09/14/2021

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Directions to “ MCKENNA E JOHNS ” Practice Location

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