Individual
TRACY MICHELLE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A
Contact information
Practice address
1221 S BROADWAY, LEXINGTON, KY 40504-2701
(859) 258-4000
Mailing address
1221 S BROADWAY, LEXINGTON, KY 40504-2701
(859) 258-6200
(859) 258-6203
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA2076
KY
363AM0700X
Medical Physician Assistant
2927
TN
363AM0700X
Medical Physician Assistant
Primary
PA2076
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100431720
—
KY
Enumeration date
02/04/2016
Last updated
10/15/2024
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