Healthcare Provider Details

I. General information

NPI: 1346186988
Provider Name (Legal Business Name): GRACE ASHTON JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 S LIMESTONE CHARLES T WETHINGTON BUILDING
LEXINGTON KY
40536-0200
US

IV. Provider business mailing address

41 KINGSBRIDGE
BRISTOL TN
37620-2959
US

V. Phone/Fax

Practice location:
  • Phone: 423-956-7554
  • Fax:
Mailing address:
  • Phone: 423-956-7554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: