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Individual

TINA RENEE JOHNSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RN

Contact information

Practice address
107 CRANES ROOST CT, ELIZABETHTOWN, KY 42701-3650
(270) 765-2605
Mailing address
107 CRANES ROOST CT, ELIZABETHTOWN, KY 42701-3650
(270) 765-2605

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
1134027
KY

Other

Enumeration date
04/23/2018
Last updated
06/16/2018
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