Healthcare Provider Details

I. General information

NPI: 1427429620
Provider Name (Legal Business Name): HANNAH JOHNSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH MOORE PA-C

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 02/09/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4359 NEW SHEPHERDSVILLE RD UNIT 245
BARDSTOWN KY
40004-8004
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 502-350-5492
  • Fax: 502-350-5822
Mailing address:
  • Phone: 606-330-7835
  • Fax: 606-330-7825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberTC438
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA2044
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: