Healthcare Provider Details

I. General information

NPI: 1922780303
Provider Name (Legal Business Name): REBEKAH JOHNSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBEKAH CARR-JOHNSON APRN

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 PARK AVE
IRONTON OH
45638-1596
US

IV. Provider business mailing address

PO BOX 2379
ASHLAND KY
41105-2379
US

V. Phone/Fax

Practice location:
  • Phone: 740-532-1100
  • Fax: 740-534-0029
Mailing address:
  • Phone: 606-408-9571
  • Fax: 606-408-6061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4006965
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: