Provider Demographics
NPI:1063065910
Name:PROFIT, JOHNESHIA (RN)
Entity type:Individual
Prefix:
First Name:JOHNESHIA
Middle Name:
Last Name:PROFIT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JOHNESHIA
Other - Middle Name:
Other - Last Name:PROFIT-THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 693
Mailing Address - Street 2:
Mailing Address - City:HOLLANDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38748-0693
Mailing Address - Country:US
Mailing Address - Phone:662-820-0450
Mailing Address - Fax:
Practice Address - Street 1:1011 E T R CLAY DR
Practice Address - Street 2:
Practice Address - City:HOLLANDALE
Practice Address - State:MS
Practice Address - Zip Code:38748-3109
Practice Address - Country:US
Practice Address - Phone:662-820-0450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS899983163W00000X, 163WH0200X
MS906430363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner