Provider Demographics
NPI:1669142477
Name:GULLION, JOANNA (NP)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:GULLION
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4179 S PLEASANT RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47138-8325
Mailing Address - Country:US
Mailing Address - Phone:812-595-7795
Mailing Address - Fax:
Practice Address - Street 1:4179 S PLEASANT RIDGE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:IN
Practice Address - Zip Code:47138-8325
Practice Address - Country:US
Practice Address - Phone:812-595-7795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016611363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily