MEDICARE: KENYUA N JOHNSON FNP-BC

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	363LF0000X	Family Nurse Practitioner	AP133762	TX
2	363LF0000X	Family Nurse Practitioner	APRN1560	HI
3	363LF0000X	Family Nurse Practitioner	66242	NM
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP133762	TX
5	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	66242	NM

General Provider Information

NPI Number	:	1669815478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENYUA N JOHNSON FNP-BC

Provider Business Mailing Address
First Line	:	12193 DOS RIOS DR APT 205
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79936-0260
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4642 N MESA ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79912-6104
Country	:	US
Telephone Number	:	915-200-2650
Fax Number	:

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

Provider Enumeration Date	:	04/10/2013
Last Update Date	:	10/31/2024

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