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Individual

KENYA JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
652 FAIRFIELD CIR, RAEFORD, NC 28376-6714
(910) 635-4448
Mailing address
652 FAIRFIELD CIR, RAEFORD, NC 28376-6714

Taxonomy

Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
376J00000X
Homemaker
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
851765661
NON-SKILLED
NC
05
851765661
NC
Enumeration date
04/24/2021
Last updated
04/24/2021
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