Individual
MATTHEW C JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
1201 PLEASANT VALLEY RD, OWENSBORO, KY 42303-9811
(270) 417-4700
(270) 417-4709
Mailing address
1201 PLEASANT VALLEY RD, OWENSBORO, KY 42303-9811
(270) 417-4700
(270) 417-4709
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1126366
KY
363LF0000X
Family Nurse Practitioner
Primary
3010190
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100388490
—
KY
Enumeration date
02/01/2016
Last updated
04/08/2016
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