Provider Demographics
NPI:1679826143
Name:JOHNSON, MONICA (APRN)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W 3RD ST STE 305
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-4129
Mailing Address - Country:US
Mailing Address - Phone:270-240-2320
Mailing Address - Fax:270-240-2320
Practice Address - Street 1:100 W 3RD ST STE 305
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-4129
Practice Address - Country:US
Practice Address - Phone:270-240-2320
Practice Address - Fax:270-228-0573
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1085736363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100224950Medicaid