Healthcare Provider Details

I. General information

NPI: 1699702332
Provider Name (Legal Business Name): ANN M JOHNSTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 KINGS DAUGHTERS DR
FRANKFORT KY
40601-6514
US

IV. Provider business mailing address

PO BOX 633815
CINCINNATI OH
45263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 502-875-5240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number32376
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: