Basic Information
| Provider Information | |||||||||
| NPI: | 1780722090 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | JANET | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | R.D., L.D., C.L.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2495 KY ROUTE 1428 | ||||||||
| Address2: | |||||||||
| City: | PRESTONSBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 416538430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068740051 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 119 RIVER DR | ||||||||
| Address2: | |||||||||
| City: | PIKEVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 415011685 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064375500 | ||||||||
| FaxNumber: | 6064339690 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | KY-KY-1963 | KY | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.