Individual
TISHA K. JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD, MPH
Contact information
Practice address
1101 VETERANS DR, LEXINGTON, KY 40502-2235
(859) 233-4511
(859) 281-3976
Mailing address
1101 VETERANS DR, LEXINGTON, KY 40502-2235
(859) 233-4511
(859) 281-3976
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01061473
IN
207R00000X
Internal Medicine Physician
35.087561
OH
207R00000X
Internal Medicine Physician
Primary
44426
KY
2083P0901X
Public Health & General Preventive Medicine Physician
44426
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000315186
OH MEDICAID UNISON
OH
05
—
200853490
—
IN
01
—
3082800
OH MEDICAID MOLINA
OH
05
—
3082800
—
OH
05
—
3810018631
—
WV
01
—
P00867121
RAILROAD MEDICARE
OH
Enumeration date
08/09/2006
Last updated
10/08/2014
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