Individual
KISSY L JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7045 IDLEWILD AVE, JENNINGS, MO 63136-1040
(314) 737-1141
Mailing address
7045 IDLEWILD AVE, JENNINGS, MO 63136-1040
(314) 737-1141
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
—
—
Other
Enumeration date
07/15/2020
Last updated
07/15/2020
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