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Individual

REBECCA LOGAN JOHNSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
2050 VERSAILLES RD, LEXINGTON, KY 40504-1405
(859) 367-7127
Mailing address
2200 FORDS MILL RD, VERSAILLES, KY 40383-8929
(859) 873-0836

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
R0212
KY

Other

Enumeration date
05/16/2007
Last updated
07/08/2007
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