Provider Demographics
NPI:1528400231
Name:JOHNSON, VIRGINIA (GINGER) LOUISE (MS,RD,LD)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA (GINGER)
Middle Name:LOUISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS,RD,LD
Other - Prefix:
Other - First Name:VIRGINIA (GINGER)
Other - Middle Name:
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,RD,LD
Mailing Address - Street 1:1180 BAKERS LN
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356-8716
Mailing Address - Country:US
Mailing Address - Phone:859-553-6851
Mailing Address - Fax:
Practice Address - Street 1:1180 BAKERS LN
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-8716
Practice Address - Country:US
Practice Address - Phone:859-553-6851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1585133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered