Provider Demographics
NPI:1861472243
Name:JOHNSON-MELTON, JANESSA BAARDA (APRN)
Entity Type:Individual
Prefix:
First Name:JANESSA
Middle Name:BAARDA
Last Name:JOHNSON-MELTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JANESSA
Other - Middle Name:B
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:286 US HIGHWAY 23 N
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-8732
Mailing Address - Country:US
Mailing Address - Phone:606-874-0032
Mailing Address - Fax:606-874-0817
Practice Address - Street 1:286 US HIGHWAY 23 N
Practice Address - Street 2:
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-8732
Practice Address - Country:US
Practice Address - Phone:606-874-0032
Practice Address - Fax:606-874-0817
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2017-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4257P363LF0000X
KY3004257363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78011970Medicaid
Q06129Medicare UPIN
KYP400018601Medicare PIN