=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265755029
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPLETE FAMILY HEALTHCARE HEATHER JOHNSTON LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2010
-----------------------------------------------------
Last Update Date | 07/11/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7138 EAST STATE ROAD 160
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47167-7855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-704-4470
-----------------------------------------------------
Fax | 877-717-2521
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 43
-----------------------------------------------------
City | HARDINSBURG
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47125-0043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-804-4470
-----------------------------------------------------
Fax | 877-717-2521
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. HEATHER E JOHNSTON
-----------------------------------------------------
Credential | ARNP
-----------------------------------------------------
Telephone | 812-704-4470
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 71002653A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------