Healthcare Provider Details

I. General information

NPI: 1154767176
Provider Name (Legal Business Name): HEATHER J. JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER J. BOWERS MD

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 PLEASANT VALLEY RD 7TH FLOOR
OWENSBORO KY
42303-9811
US

IV. Provider business mailing address

PO BOX 23229
OWENSBORO KY
42304-3229
US

V. Phone/Fax

Practice location:
  • Phone: 270-417-4705
  • Fax: 270-417-4709
Mailing address:
  • Phone: 270-691-8070
  • Fax: 270-691-8026

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberTP357
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number49491
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: