Individual
KIARRAH TAKIYAH JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
23 S CANARY WAY, GALLOWAY, NJ 08205-6208
(609) 204-6599
Mailing address
23 S CANARY WAY, GALLOWAY, NJ 08205-6208
(609) 204-6599
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
25MT00323600
NJ
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/23/2021
Last updated
11/25/2023
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