Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 2002-00267 | NC |
N | 208600000X | Surgeon | 2002-00267 | NC |
Y | 208200000X | Surgeon | 44838 | KY |
Y | 208600000X | Surgeon | 44838 | KY |
N | 2086S0129X | Vascular Surgeon | 230012 | MA |
NPI | 1003811985 |
---|---|
Provider Name | Amy O Johnson |
First Address | Pikeville, KY 41502-0432 |
Second Address | Pikeville, KY 41501-1546 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2005 |
Last Update Date | 07/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7100195700 | (05) | KY |
89126X4 | (05) | NC |
I07610 | (02) | NC |