Provider Demographics
NPI:1700177292
Name:JOHNSON, JILL M (APRN)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:M
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:PO BOX 1150
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-5150
Mailing Address - Country:US
Mailing Address - Phone:606-546-9287
Mailing Address - Fax:606-546-2860
Practice Address - Street 1:PO BOX 1150
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-5150
Practice Address - Country:US
Practice Address - Phone:606-546-9287
Practice Address - Fax:606-546-2860
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006871363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100167610Medicaid