Provider Demographics
NPI:1275700692
Name:JOHNSON, RACHEL (ARNP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 CYPRESS WAY
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-8423
Mailing Address - Country:US
Mailing Address - Phone:859-699-1275
Mailing Address - Fax:
Practice Address - Street 1:1001 CHERRY BLOSSOM WAY
Practice Address - Street 2:TMMK 2000 CLINIC
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-9564
Practice Address - Country:US
Practice Address - Phone:502-868-4845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-14
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5688363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily