1881956027 NPI number — MRS. ASHLEY ELIZABETH JOHNSON APRN

Table of content: MRS. ASHLEY ELIZABETH JOHNSON APRN (NPI 1881956027)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881956027 NPI number — MRS. ASHLEY ELIZABETH JOHNSON APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
ASHLEY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BECRAFT
Provider Other First Name:
ASHLEY
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1881956027
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
784 HIGHWAY 36
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRENCHBURG
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40322-8123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-768-9190
Provider Business Mailing Address Fax Number:
606-768-9180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 FOXGLOVE DR
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
MT STERLING
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40353-9735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-498-3333
Provider Business Practice Location Address Fax Number:
859-498-3332
Provider Enumeration Date:
06/13/2012

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:  3007477 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7100208750 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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