Provider Demographics
NPI:1306802111
Name:JOHNSON, KAY ANN (MD)
Entity type:Individual
Prefix:
First Name:KAY
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636256 CENTRAL CREDENTIALING
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-5501
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:9275 MONTGOMERY RD
Practice Address - Street 2:STE 200
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-7779
Practice Address - Country:US
Practice Address - Phone:513-936-4510
Practice Address - Fax:513-936-4511
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-057032207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64864275Medicaid
OH110228310OtherRAIL ROAD MEDICARE
OH0796867Medicaid
IN200036210Medicaid
OHJO0826868Medicare PIN
IN200036210Medicaid