Individual
HEATHER J. JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1201 PLEASANT VALLEY RD, 7TH FLOOR, OWENSBORO, KY 42303-9811
(270) 417-4705
(270) 417-4709
Mailing address
PO BOX 23229, OWENSBORO, KY 42304-3229
(270) 691-8070
(270) 691-8026
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
49491
KY
208000000X
Pediatrics Physician
TP357
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100418510
—
KY
Enumeration date
05/16/2013
Last updated
04/18/2017
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