Individual
MARY JOHANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2201 LEXINGTON AVE, ASHLAND, KY 41101-2843
(606) 408-4000
Mailing address
3112 DUBLIN DR, BISMARCK, ND 58503-6424
(701) 527-9235
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
TP529
KY
208000000X
Pediatrics Physician
Primary
TP529
KY
Other
Enumeration date
03/20/2021
Last updated
08/13/2025
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