Provider Demographics
NPI:1063249373
Name:TOLBERT-JOHNSON, KYTORI (RN, MSN, APRN, FNP)
Entity type:Individual
Prefix:
First Name:KYTORI
Middle Name:
Last Name:TOLBERT-JOHNSON
Suffix:
Gender:F
Credentials:RN, MSN, APRN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 SUNDANCE CT
Mailing Address - Street 2:
Mailing Address - City:MATTESON
Mailing Address - State:IL
Mailing Address - Zip Code:60443-1286
Mailing Address - Country:US
Mailing Address - Phone:773-941-9750
Mailing Address - Fax:
Practice Address - Street 1:2955 W 95TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2409
Practice Address - Country:US
Practice Address - Phone:708-423-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041468791163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse