Individual
AMY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
13 PALMER AVE, EVERGREEN MEDICAL CENTER, CORINTH, NY 12822-1145
(518) 654-6499
(518) 654-7303
Mailing address
100 PARK STREE, GLENS FALLS HOSPITAL - CREDENTIALING, GLENS FALLS, NY 12801-4413
(518) 926-5924
(518) 926-6983
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
004694
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02347657
—
NY
01
—
P00326248
RR MEDICARE
NY
Enumeration date
11/07/2005
Last updated
09/01/2021
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