Provider Demographics
NPI:1316398977
Name:SHOWN, JOHNNA C (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JOHNNA
Middle Name:C
Last Name:SHOWN
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:4915 NORTON HEALTHCARE BLVD STE 301
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2860
Practice Address - Country:US
Practice Address - Phone:502-394-6460
Practice Address - Fax:502-394-6465
Is Sole Proprietor?:No
Enumeration Date:2016-06-24
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3010319363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
6043312OtherAETNA PIN
KY7100465120Medicaid
CS1811300243OtherCARESOURCE ID
000001083714OtherANTHEM PIN
IN300009605Medicaid