Provider Demographics
NPI:1235284720
Name:JOHNSON, RAMONA (ARNP, CS)
Entity Type:Individual
Prefix:MS
First Name:RAMONA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ARNP, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-2288
Mailing Address - Country:US
Mailing Address - Phone:502-585-9444
Mailing Address - Fax:502-585-9466
Practice Address - Street 1:950 S 1ST ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2288
Practice Address - Country:US
Practice Address - Phone:502-585-9444
Practice Address - Fax:502-585-9466
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1035573163WP0809X
KY2085S363LP0808X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9033Medicaid
KY228847000OtherMAGELLAN
KY407089013OtherTRICARE
KY000000219646OtherANTHEM
KY407089013OtherTRICARE
KY0320711Medicare ID - Type Unspecified