| Doctor Name: | TRACY JOHNSON |
| NPI Number: | 1215229240 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | 3006924 |
| Business Practice Address: | 201 S 5th St Bardstown, KY - 400041142 |
| Business Phone Number: | 5023485968 |
| Business Fax Number: | 5023490963 |
| Mailing Address: | 201 S 5th St, BARDSTOWN |
| State: | KY |
| Postal Code: | 400041142 |
| Phone Number: | 5023485968 |
| Fax Number: | 5023490963 |
| NPI Enumeration Date: | 05/10/2011 |
| NPI Last Update Date: | 12/13/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 3006924 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | KY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |