Organization
1025 HEALTH, LLC
Active
Parent organization
1104270
Organization subpart
Yes
Provider details
NPI number
Legal business name
1104270
Authorized official
MR. ROBERT JOHNSON APRN (NP)
(606) 451-9748
Entity
Organization
Contact information
Practice address
110 HARDIN LN, SOMERSET, KY 42503-3818
(606) 451-9748
Mailing address
110 HARDIN LN, SOMERSET, KY 42503-3818
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
—
—
363LG0600X
Gerontology Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417467010
—
KY
Enumeration date
07/21/2020
Last updated
07/21/2020
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