1639775729 NPI number — DENISE N JOHNSON NP

Table of content: DENISE N JOHNSON NP (NPI 1639775729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639775729 NPI number — DENISE N JOHNSON NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
DENISE
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639775729
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4600 MONTGOMERY RD STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45212-2600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
833-510-4357
Provider Business Mailing Address Fax Number:
866-460-2997

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5464 BURKHARDT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45431-2112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
833-510-4357
Provider Business Practice Location Address Fax Number:
866-460-2997
Provider Enumeration Date:
12/05/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  APRN.CNP.0027793 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: RN.347213 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0427067 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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