Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 3008934 | KY |
NPI | 1043616808 |
---|---|
Provider Name | Ms. Julia Johnstone |
First Address | Betsy Layne, KY 41605-0112 |
Second Address | Harold, KY 41635-7064 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2014 |
Last Update Date | 07/12/2020 |