Provider Demographics
NPI:1275836504
Name:JOHNSON, EMILY O'BRYAN (ARNP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:O'BRYAN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:O'BRYAN
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:3198 CUSTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-4074
Mailing Address - Country:US
Mailing Address - Phone:859-231-6996
Mailing Address - Fax:866-559-1302
Practice Address - Street 1:3198 CUSTER DR STE 100
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-4074
Practice Address - Country:US
Practice Address - Phone:859-231-6996
Practice Address - Fax:866-559-1302
Is Sole Proprietor?:No
Enumeration Date:2010-12-08
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY6745P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily