Individual
KENICHA MONTA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
423 N HINDS ST, GREENVILLE, MS 38701-2929
(662) 537-8547
Mailing address
423 N HINDS ST, GREENVILLE, MS 38701-2929
(662) 537-8547
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
A059764
MS
376J00000X
Homemaker
Primary
—
—
376K00000X
Nurse's Aide
A059764
MS
Other
Enumeration date
06/10/2013
Last updated
06/10/2013
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