Provider Demographics
NPI:1770127847
Name:JOHNSON, NESIA
Entity type:Individual
Prefix:MRS
First Name:NESIA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 S BROADWAY ST STE 105
Mailing Address - Street 2:
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648-5168
Mailing Address - Country:US
Mailing Address - Phone:601-814-9703
Mailing Address - Fax:601-873-1810
Practice Address - Street 1:529 S BROADWAY ST STE 105
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648-5168
Practice Address - Country:US
Practice Address - Phone:601-600-6677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-01
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care
No251E00000XAgenciesHome Health