Individual
TERRY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
320 LORETTO RD, LEBANON, KY 40033-1300
(270) 692-3161
Mailing address
425 LEWIS HARGETT CIR, LEXINGTON, KY 40503-3590
(859) 268-1030
(859) 269-4120
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
3000970
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
74340670
—
KY
Enumeration date
08/19/2005
Last updated
05/07/2014
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