Healthcare Provider Details

I. General information

NPI: 1861472243
Provider Name (Legal Business Name): JANESSA BAARDA JOHNSON-MELTON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANESSA B JOHNSON NP

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL CENTER DR
HAZARD KY
41701-9466
US

IV. Provider business mailing address

200 MEDICAL CENTER DR
HAZARD KY
41701-9466
US

V. Phone/Fax

Practice location:
  • Phone: 606-487-7955
  • Fax:
Mailing address:
  • Phone: 606-487-7955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4257P
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3004257
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: