Individual
MALLORY QUINN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
449 KELSO TRL, CORBIN, KY 40701-8502
(606) 273-6971
Mailing address
449 KELSO TRL, CORBIN, KY 40701-8502
(606) 273-6971
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1129317
KY
367500000X
Certified Registered Nurse Anesthetist
Primary
3015641
KY
Other
Enumeration date
09/24/2020
Last updated
01/15/2021
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