Provider Demographics
NPI:1386793008
Name:HOUSTON, JOHN A (ARNP)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:HOUSTON
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 MARKET ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47111-9535
Mailing Address - Country:US
Mailing Address - Phone:812-503-5100
Mailing Address - Fax:502-489-5733
Practice Address - Street 1:1802 E 10TH ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-6016
Practice Address - Country:US
Practice Address - Phone:812-288-2488
Practice Address - Fax:502-935-9577
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3599P2083X0100X, 363L00000X
IN71010470A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3599POtherNURSE PRACTIONER LICENSE
KY1097323OtherREGISTERED NURSE LICENSE