Kissy L Johnson | Jennings, MO • PECOS Search

Kissy L Johnson

Home Health

Agencies

7045 Idlewild Ave, Jennings, MO 63136-1040

PECOS Enrollment

Based on the most recent information from CMS, provider Kissy L Johnson does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 3 days ago.

Profile Details

Provider ID
1770191728
Provider Type
Individual
Full Name
Johnson, Kissy L
Gender
Female

Sole Proprietor
Yes
Enumeration Date
7/15/2020
Last Updated
7/15/2020

Contact Information

Practice Location

7045 Idlewild Ave, Jennings, MO 63136-1040

Unlisted Fax

Mailing Location

7045 Idlewild Ave, Jennings, MO 63136-1040

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 251E00000X Primary	Description Home Health Agencies	License Unlisted Issuer