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General NPI Number Information
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NPI Number | 1083935019
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Entity Type | Organization
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Legal Business Name | KEVIN BRANDT JOHNSON, PSC
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Dates
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Enumeration Date | 06/14/2010
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Last Update Date | 06/14/2010
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Provider Practice Location Address
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Address Line | 140 ADAMS LANE SUITE 600
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City | PIKEVILLE
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State | KY
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Zip | 41501-1689
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Country | US
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Telephone | 606-639-6538
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Fax |
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Provider Business Mailing Address
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Address Line | 140 ADAMS LANE SUITE 600
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City | PIKEVILLE
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State | KY
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Zip | 41501-1689
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN BRANDT JOHNSON
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Credential | MD
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Telephone | 606-639-6538
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 03105
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License Number State | KY
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