Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | MW185 | FL |
NPI | 1023200631 |
---|---|
Provider Name | Ms. Kerri Miranda Johnson |
First Address | St Augustine, FL 32084-4406 |
Second Address | St Augustine, FL 32084-4406 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2007 |
Last Update Date | 16/08/2007 |