Provider Demographics
NPI:1124564083
Name:JOHNSON, MEREDITH N (APRN)
Entity type:Individual
Prefix:
First Name:MEREDITH
Middle Name:N
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:N
Other - Last Name:BASHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:5300 STATE ROAD 64 STE 103
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47122-9178
Mailing Address - Country:US
Mailing Address - Phone:812-923-6200
Mailing Address - Fax:812-923-6204
Practice Address - Street 1:5300 STATE ROAD 64 STE 103
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:IN
Practice Address - Zip Code:47122-9178
Practice Address - Country:US
Practice Address - Phone:812-923-6200
Practice Address - Fax:812-923-6204
Is Sole Proprietor?:No
Enumeration Date:2017-01-16
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012674363LF0000X
IN28197992A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300000287Medicaid
ININ1189162OtherIN MEDICARE