Individual
ETHAN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3900 KRESGE WAY STE 60, LOUISVILLE, KY 40207-4690
(502) 897-8008
Mailing address
3900 KRESGE WAY, LOUISVILLE, KY 40207-4660
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
4024171
KY
Other
Enumeration date
08/28/2024
Last updated
08/28/2024
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