Healthcare Provider Details

I. General information

NPI: 1467084822
Provider Name (Legal Business Name): MRS. ALLISON DAWN JOHNSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2157 S HIGHWAY 27
STEARNS KY
42647-6297
US

IV. Provider business mailing address

216 TALON TRL
LONDON KY
40744-6309
US

V. Phone/Fax

Practice location:
  • Phone: 606-376-9700
  • Fax:
Mailing address:
  • Phone: 606-862-8286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3013825
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: