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General NPI Number Information
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NPI Number | 1346586153
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Entity Type | Individual
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Provider Name | DEBRA LYNN JOHNSON APRN
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Gender | Female
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Dates
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Enumeration Date | 12/26/2012
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Last Update Date | 12/26/2012
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Provider Practice Location Address
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Address Line | 1311 N DIXIE HWY
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-2621
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Country | US
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Telephone | 270-360-0419
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Fax | 270-360-1609
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Provider Business Mailing Address
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Address Line | 107 CRANES ROOST CT
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City | ELIZABETHTOWN
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State | KY
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Zip | 42701-3650
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Country | US
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Telephone | 270-765-2605
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Fax | 270-234-8572
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 3007802
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License Number State | KY
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