MEDICARE: KIMBERLY A JOHNSON APRN

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	138414	MO
2	363LF0000X	Family Nurse Practitioner	0024177320	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01230388	OTHER	MO	RR MEDICARE

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
3	138414	OTHER	MO	RN FNPC LICENSE NUMBER

General Provider Information

NPI Number	:	1730150889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY A JOHNSON APRN

Provider Business Mailing Address
First Line	:	100 ENTERPRISE DR
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23692-3190
Country	:	US
Telephone Number	:	757-736-3725
Fax Number	:	757-431-7782

Provider Business Practice Location Address
First Line	:	100 ENTERPRISE DR
Second Line	:
City	:	YORKTOWN
State	:	VA
Zip	:	23692-3190
Country	:	US
Telephone Number	:	757-736-3725
Fax Number	:	757-431-7782

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

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	01/16/2023

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Directions to “ KIMBERLY A JOHNSON APRN” Practice Location

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