Provider Demographics
NPI:1528430907
Name:DELL, JOHNNIE SUE (APRN)
Entity type:Individual
Prefix:
First Name:JOHNNIE
Middle Name:SUE
Last Name:DELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JOHNNIE
Other - Middle Name:SUE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:73 THOMPSON POYNTER RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-7202
Mailing Address - Country:US
Mailing Address - Phone:606-877-1446
Mailing Address - Fax:606-877-1285
Practice Address - Street 1:73 THOMPSON POYNTER RD
Practice Address - Street 2:SUITE A
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-7202
Practice Address - Country:US
Practice Address - Phone:606-877-1446
Practice Address - Fax:606-877-1285
Is Sole Proprietor?:No
Enumeration Date:2015-10-26
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40962363LF0000X
KY3009868363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily