Healthcare Provider Details

I. General information

NPI: 1386793008
Provider Name (Legal Business Name): JOHN A HOUSTON ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 05/15/2023
Certification Date: 05/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 E 10TH ST
JEFFERSONVILLE IN
47130-6016
US

IV. Provider business mailing address

2100 MARKET ST STE 100
CHARLESTOWN IN
47111-9535
US

V. Phone/Fax

Practice location:
  • Phone: 812-288-2488
  • Fax: 502-935-9577
Mailing address:
  • Phone: 812-503-5100
  • Fax: 502-489-5733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number3599P
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3599P
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71010470A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: