Basic Information
| Provider Information | |||||||||
| NPI: | 1386793008 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOUSTON | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 MARKET ST STE 100 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTOWN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471119535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8125035100 | ||||||||
| FaxNumber: | 5024895733 | ||||||||
| Practice Location | |||||||||
| Address1: | 1802 E 10TH ST | ||||||||
| Address2: | |||||||||
| City: | JEFFERSONVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471306016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122882488 | ||||||||
| FaxNumber: | 5029359577 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2007 | ||||||||
| LastUpdateDate: | 07/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083X0100X | 3599P | KY | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine | 363L00000X | 3599P | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1097323 | 01 | KY | REGISTERED NURSE LICENSE | OTHER | 3599P | 01 | KY | NURSE PRACTIONER LICENSE | OTHER |