Provider Demographics
NPI:1932241171
Name:JOHNSON, KIMBERLY JASMINE (PMHNP)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:JASMINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 ROBERT ROSE DR BLDG B
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-6347
Mailing Address - Country:US
Mailing Address - Phone:615-295-8272
Mailing Address - Fax:615-634-3176
Practice Address - Street 1:275 ROBERT ROSE DR BLDG B
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-6347
Practice Address - Country:US
Practice Address - Phone:414-628-5782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34948363LP0808X
TN6632101YM0800X
TN262592163W00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No171M00000XOther Service ProvidersCase Manager/Care Coordinator