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General NPI Number Information
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NPI Number | 1497519599
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Entity Type | Individual
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Provider Name | SARA JOHNSON PMHNP
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Gender | Female
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Dates
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Enumeration Date | 02/08/2024
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Last Update Date | 02/08/2024
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Provider Practice Location Address
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Address Line | 828 LANE ALLEN RD STE 219
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City | LEXINGTON
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State | KY
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Zip | 40504-3659
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Country | US
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Telephone | 260-483-9081
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Fax |
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Provider Business Mailing Address
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Address Line | 1102 WINNERS CIR APT 11
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City | LOUISVILLE
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State | KY
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Zip | 40242-7549
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Country | US
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Telephone | 317-498-3244
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Fax |
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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 | 4011430
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License Number State | KY
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