Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mary Johanson

Individual provider Internal Medicine Physician · NPI 1194301192

Mary Johanson is a Pediatric Medicine in Ashland, Kentucky. Qualified in 2021, 5 years ago. Practices with Kings Daughters Medical Specialties Inc, a 387-clinician group and accepts Medicare assignment. Licensed in Kentucky.

Years since qualifying
5
Licensed in
KY
In the registry since
2021
Specialties on file
2
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Practice location Address checks out

2201 Lexington Ave
Ashland, KY 41101-2843
Phone: (606) 408-4000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Pediatrics Physician (primary) Taxonomy 208000000X · Licence TP529 (KY)
Internal Medicine Physician Taxonomy 207R00000X · Licence TP529 (KY)

Record details

NPI number1194301192
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorNo
NPI enumeratedMarch 20, 2021
Last updated in NPPESAugust 13, 2025
Certification dateAugust 13, 2025
Mailing address3112 Dublin Dr, Bismarck, ND 58503-6424

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPEDIATRIC MEDICINE
Medical schoolOTHER
Graduated 2021 (5 years in practice)
Group practice Kings Daughters Medical Specialties Inc — 387 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Ashland