Individual
STACEY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
464 KY HIGHWAY 699, CORNETTSVILLE, KY 41731
(606) 476-2593
(606) 476-2347
Mailing address
PO BOX 40, WHITESBURG, KY 41858
(606) 633-4823
(606) 633-1874
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
38781
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64881600
—
KY
Enumeration date
06/26/2006
Last updated
07/08/2007
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