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NPI Code Detail

MEDICARE: KIMBERLY DEJOHN APRN

MEDICARE: KIMBERLY DEJOHN 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
1363L00000XNurse Practitioner3012408KY
2363LF0000XFamily Nurse Practitioner3012408KY

General Provider Information

NPI Number : 1891286225
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY DEJOHN APRN
Provider Business Mailing Address
First Line : 1428 COPPER GLEN DR
Second Line :
City : LEXINGTON
State : KY
Zip : 40514-1297
Country : US
Telephone Number : 859-552-8799
Fax Number :
Provider Business Practice Location Address
First Line : 3175 BEAUMONT CENTRE CIR
Second Line :
City : LEXINGTON
State : KY
Zip : 40513-1957
Country : US
Telephone Number : 859-219-5152
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2018
Last Update Date : 11/07/2022

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Directions to “ KIMBERLY DEJOHN APRN” Practice Location

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