Provider Demographics
NPI:1396889978
Name:JOHNSON, FELICIA GAIL (CFA)
Entity type:Individual
Prefix:MS
First Name:FELICIA
Middle Name:GAIL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CFA
Other - Prefix:MRS
Other - First Name:FELICIA
Other - Middle Name:GAIL
Other - Last Name:BOGAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CFA
Mailing Address - Street 1:PO BOX 950248
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0248
Mailing Address - Country:US
Mailing Address - Phone:502-253-1035
Mailing Address - Fax:502-253-1037
Practice Address - Street 1:3900 KRESGE WAY
Practice Address - Street 2:SUITE 51
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4660
Practice Address - Country:US
Practice Address - Phone:502-259-5955
Practice Address - Fax:502-259-5953
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYSA146246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000602589OtherANTHEM- NORTON NEUROSURGICAL INSTITUTE OF KENTUCKY