Provider Demographics
NPI:1386112688
Name:JOHNSTON, BRENDA (APRN)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6801 DIXIE HWY STE 132
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3952
Mailing Address - Country:US
Mailing Address - Phone:502-657-2701
Mailing Address - Fax:
Practice Address - Street 1:6801 DIXIE HWY STE 132
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40258-3952
Practice Address - Country:US
Practice Address - Phone:502-657-2701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN61779NP363LF0000X
KY4011663363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily