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NPI Code Detail

MEDICARE: AUDREY JOHNSON

MEDICARE: AUDREY JOHNSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679795736
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUDREY JOHNSON
Provider Business Mailing Address
First Line : PO BOX 790
Second Line :
City : ASHLAND
State : KY
Zip : 41105-0790
Country : US
Telephone Number : 606-329-8588
Fax Number : 606-329-8195
Provider Business Practice Location Address
First Line : 3701 LANDSDOWNE DR
Second Line :
City : ASHLAND
State : KY
Zip : 41102-5422
Country : US
Telephone Number : 606-329-8588
Fax Number : 606-475-3219
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2007
Last Update Date : 02/12/2025

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Directions to “ AUDREY JOHNSON ” Practice Location

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