MEDICARE: KELAYLA MICHELLE RANKIN 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	374700000X	Technician	PF4N6M7A5	AL

General Provider Information

NPI Number	:	1922878545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELAYLA MICHELLE RANKIN JOHNSON

Provider Business Mailing Address
First Line	:	1005 RUTLEDGE WAY
Second Line	:
City	:	FAIRFIELD
State	:	AL
Zip	:	35064-1552
Country	:	US
Telephone Number	:	205-834-6380
Fax Number	:

Provider Business Practice Location Address
First Line	:	2406 AVENUE J
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35218-1837
Country	:	US
Telephone Number	:	205-834-6380
Fax Number	:

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

Provider Enumeration Date	:	01/04/2024
Last Update Date	:	01/04/2024

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