MEDICARE: TAMICA TITANYA 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	363LG0600X	Gerontology Nurse Practitioner	2021043562	MO

General Provider Information

NPI Number	:	1891449013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMICA TITANYA JOHNSON

Provider Business Mailing Address
First Line	:	12000 WORNALL RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64145-1117
Country	:	US
Telephone Number	:	816-213-7539
Fax Number	:

Provider Business Practice Location Address
First Line	:	12000 WORNALL RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64145-1117
Country	:	US
Telephone Number	:	816-941-1000
Fax Number	:

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

Provider Enumeration Date	:	02/07/2022
Last Update Date	:	02/07/2022

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