MEDICARE: ASHLEY R JOHNSON REGISTERED NURSE

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	363LF0000X	Family Nurse Practitioner	53-85272-081	KS
2	163W00000X	Registered Nurse	28236890A	IN
3	363LF0000X	Family Nurse Practitioner	71014073A	IN

General Provider Information

NPI Number	:	1760197495
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY R JOHNSON REGISTERED NURSE

Provider Business Mailing Address
First Line	:	1444 SOUTHVIEW DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-5028
Country	:	US
Telephone Number	:	317-625-6945
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 N MAIN ST # 304
Second Line	:
City	:	CROWN POINT
State	:	IN
Zip	:	46307-1877
Country	:	US
Telephone Number	:	574-546-1900
Fax Number	:	574-546-1999

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

Provider Enumeration Date	:	01/17/2023
Last Update Date	:	03/27/2026

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