Provider Demographics
NPI:1780157057
Name:JOHNSON, TAMMY (ARNP)
Entity type:Individual
Prefix:PROF
First Name:TAMMY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:TAMMY
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:1553 HIGHWAY 44 E
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-7183
Mailing Address - Country:US
Mailing Address - Phone:502-543-2433
Mailing Address - Fax:
Practice Address - Street 1:4822 PRESTON HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-2226
Practice Address - Country:US
Practice Address - Phone:502-969-2227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-09
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3013055363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily