Provider Demographics
NPI:1063207520
Name:SMITH, JOHNEKA LOVE
Entity type:Individual
Prefix:
First Name:JOHNEKA
Middle Name:LOVE
Last Name:SMITH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4709 ADDISON RD
Mailing Address - Street 2:
Mailing Address - City:CAPITOL HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20743-1102
Mailing Address - Country:US
Mailing Address - Phone:301-213-6109
Mailing Address - Fax:
Practice Address - Street 1:1431 BELLE HAVEN DR
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-4416
Practice Address - Country:US
Practice Address - Phone:301-448-5476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-14
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCL00007794957374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide