Individual
EBONY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1000 W 101ST TER, KANSAS CITY, MO 64114-4556
(832) 737-8777
Mailing address
PO BOX 140202, KANSAS CITY, MO 64114-0202
(816) 803-6162
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
453081878
—
TX
Enumeration date
05/08/2020
Last updated
03/26/2021
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