Individual
DR. STEPHEN KENNEDY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D.
Contact information
Practice address
10211 WESTPORT RD, LOUISVILLE, KY 40241-2147
(502) 339-0444
(502) 339-1717
Mailing address
PO BOX 776879, CHICAGO, IL 60677-6879
(502) 272-5395
(502) 272-5339
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
1376
KY
208000000X
Pediatrics Physician
Primary
46857
KY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000885933
ANTHEM-NCMA
KY
01
—
165151
SIHO-NCMA
KY
01
—
50079132
PASSPORT-NCMA
KY
05
—
7100215230
—
KY
Enumeration date
07/05/2007
Last updated
04/13/2021
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