MEDICARE: JOHNNA LEIGH GAY PMHNP

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
1	2084P0800X	Psychiatry Physician	4030476	KY
2	2084P0804X	Child & Adolescent Psychiatry Physician	4030476	KY
3	2084P0805X	Geriatric Psychiatry Physician	4030476	KY
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	4030476	KY

General Provider Information

NPI Number	:	1528882636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHNNA LEIGH GAY PMHNP

Provider Business Mailing Address
First Line	:	200 MULBERRY ST STE A
Second Line	:
City	:	BOONEVILLE
State	:	KY
Zip	:	41314-7505
Country	:	US
Telephone Number	:	606-593-6023
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 MULBERRY ST STE A
Second Line	:
City	:	BOONEVILLE
State	:	KY
Zip	:	41314-7505
Country	:	US
Telephone Number	:	606-593-6023
Fax Number	:	606-593-6087

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2024
Last Update Date	:	07/31/2025

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