Individual
KIMBERLY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, NP
Contact information
Practice address
445 BROADHOLLOW RD STE 25, MELVILLE, NY 11747-3645
(631) 223-8852
(631) 350-0331
Mailing address
118 SUFFOLK AVE, BRENTWOOD, NY 11717-4202
(631) 336-0190
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
321125
NC
163W00000X
Registered Nurse
655384
PA
163W00000X
Registered Nurse
661348
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
310859
NY
Other
Enumeration date
03/25/2016
Last updated
11/13/2025
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