Healthcare Provider Details

I. General information

NPI: 1285644146
Provider Name (Legal Business Name): TISHA K. JOHNSON MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 VETERANS DR
LEXINGTON KY
40502-2235
US

IV. Provider business mailing address

1101 VETERANS DR
LEXINGTON KY
40502-2235
US

V. Phone/Fax

Practice location:
  • Phone: 859-233-4511
  • Fax: 859-281-3976
Mailing address:
  • Phone: 859-233-4511
  • Fax: 859-281-3976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01061473
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.087561
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number44426
License Number StateKY
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number44426
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: