MEDICARE: KENNETH 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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1932565280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH JOHNSON

Provider Business Mailing Address
First Line	:	1138 N. DUPRE ST.
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-2609
Country	:	US
Telephone Number	:	504-330-1998
Fax Number	:

Provider Business Practice Location Address
First Line	:	1138 N DUPRE ST
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70119-3204
Country	:	US
Telephone Number	:	504-330-1998
Fax Number	:	504-330-1998

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

Provider Enumeration Date	:	12/31/2015
Last Update Date	:	07/21/2022

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Directions to “ KENNETH JOHNSON ” Practice Location

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