1780467951 NPI number — MISS RHODONA KYLE JOHNSON CNIM

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 1780467951 NPI number — MISS RHODONA KYLE JOHNSON CNIM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
RHODONA
Provider Middle Name:
KYLE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
CNIM
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:
1780467951
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
750 OLD HICKORY BLVD
Provider Second Line Business Mailing Address:
BLDG 2, STE 150
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-5387
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-351-8459
Provider Business Mailing Address Fax Number:
484-351-8810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
750 OLD HICKORY BLVD
Provider Second Line Business Practice Location Address:
BLDG 2, STE 150
Provider Business Practice Location Address City Name:
BRENTWOOD
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37027-5387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-351-8459
Provider Business Practice Location Address Fax Number:
484-351-8810
Provider Enumeration Date:
08/14/2023

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: 246ZE0600X , with the licence number:  5212 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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