Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 5648 | TN |
NPI | 1003841339 |
---|---|
Provider Name | Marcia L Johnston |
First Address | Louisville, KY 40223-2992 |
Second Address | Memphis, TN 38119-4810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2006 |
Last Update Date | 23/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3344174 | (02) | TN |