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General NPI Number Information
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NPI Number | 1508204033
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Entity Type | Individual
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Provider Name | ANDREA RAE JOHNSTON L.AC
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Gender | Female
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Dates
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Enumeration Date | 06/06/2013
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Last Update Date | 07/15/2021
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Provider Practice Location Address
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Address Line | 306 MIDDLETOWN PARK PL STE C
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City | LOUISVILLE
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State | KY
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Zip | 40243-2517
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Country | US
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Telephone | 502-742-8613
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Fax |
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Provider Business Mailing Address
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Address Line | 4203 BROWNSBORO GLEN RD
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City | LOUISVILLE
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State | KY
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Zip | 40241-1198
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Country | US
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Telephone | 714-357-7347
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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 | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC082
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License Number State | KY
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