Provider Demographics
NPI:1538866686
Name:JOHNSON, MARTHA ALMIRA (APRN)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:ALMIRA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 OSBOURNE WAY # 101
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8004
Mailing Address - Country:US
Mailing Address - Phone:502-570-0007
Mailing Address - Fax:
Practice Address - Street 1:111 OSBOURNE WAY # 101
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-8004
Practice Address - Country:US
Practice Address - Phone:502-570-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3019019363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily