1366084824 NPI number — NIKITA JOHNSON CPM, DOULA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366084824 NPI number — NIKITA JOHNSON CPM, DOULA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
NIKITA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPM, DOULA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366084824
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5024 DORSEY HALL DR # 203-D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLICOTT CITY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21042-7869
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
667-303-2336
Provider Business Mailing Address Fax Number:
410-204-5176

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5024 DORSEY HALL DR # 203-D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELLICOTT CITY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21042-7869
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
667-303-2336
Provider Business Practice Location Address Fax Number:
410-204-5176
Provider Enumeration Date:
10/16/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367A00000X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000000000000000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000000000000000 . This is a "NURSING SERVICE RELATED PROVIDERS TYPE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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