Individual
AMIYA JADA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1400 75TH ST, KENOSHA, WI 53143-1544
(262) 909-6008
Mailing address
1400 75TH ST, KENOSHA, WI 53143-1544
(262) 909-6008
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
041.518035
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
16909-33
WI
Other
Enumeration date
09/21/2023
Last updated
10/20/2025
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