Provider Demographics
NPI:1386301075
Name:JOHNSON, DENNIS (APRN)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1951 BISHOP LN STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1950
Mailing Address - Country:US
Mailing Address - Phone:502-446-5610
Mailing Address - Fax:502-446-5619
Practice Address - Street 1:1951 BISHOP LN STE 300
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1950
Practice Address - Country:US
Practice Address - Phone:502-446-5610
Practice Address - Fax:502-446-5619
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016854363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health