| Doctor Name: | POLLY JOHNSON |
| NPI Number: | 1760793285 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | 3006484 |
| Business Practice Address: | 59 Cowtown Rd Hindman, KY - 418229120 |
| Business Phone Number: | 6067853175 |
| Business Fax Number: | 6067859968 |
| Mailing Address: | 59 Cowtown Rd, HINDMAN |
| State: | KY |
| Postal Code: | 418229120 |
| Phone Number: | 6067853175 |
| Fax Number: | 6067859968 |
| NPI Enumeration Date: | 06/30/2010 |
| NPI Last Update Date: | 05/14/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 3006484 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | KY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |