Provider Demographics
NPI:1457360398
Name:JOHNSON, PAULA D (MD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAULA
Other - Middle Name:M
Other - Last Name:DIX DENNERLEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6478 LORETTO RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40069-9346
Mailing Address - Country:US
Mailing Address - Phone:253-431-7011
Mailing Address - Fax:
Practice Address - Street 1:6478 LORETTO RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:KY
Practice Address - Zip Code:40069-9346
Practice Address - Country:US
Practice Address - Phone:253-431-7011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.165323207R00000X
AL46686207R00000X
GA96479207R00000X
TN68954207R00000X
WI3138-320207R00000X
TXU5008207R00000X
WAIMLC.MD.61456251207R00000X
OH35C.000691207R00000X
OK41884207R00000X
IN01090638A207R00000X
LA336937207R00000X
MS32147207R00000X
KY40698207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYTP692OtherSTATE LIC
NE20455OtherSTATE