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NPI Code Detail

MEDICARE: MARLA SMITH JOHNSON APRN

MEDICARE: MARLA SMITH JOHNSON APRN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner3003587KY
2363L00000XNurse Practitioner71014669AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4500023900OTHERPALMETTO GBA-RAILROAD MEDICARE
6P00942703OTHERKYRAIL ROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00954941OTHERKYRAIL ROAD MEDDICARE
2000000225922OTHERANTHEM
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1104821982
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARLA SMITH JOHNSON APRN
Provider Business Mailing Address
First Line : PO BOX 636324
Second Line :
City : CINCINNATI
State : OH
Zip : 45263-6324
Country : US
Telephone Number : 859-301-2000
Fax Number : 859-301-6910
Provider Business Practice Location Address
First Line : 1 MEDICAL VILLAGE DR
Second Line :
City : EDGEWOOD
State : KY
Zip : 41017-3403
Country : US
Telephone Number : 859-301-2000
Fax Number : 859-301-6910
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/17/2005
Last Update Date : 12/18/2025

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Directions to “ MARLA SMITH JOHNSON APRN” Practice Location

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