Healthcare Provider Details

I. General information

NPI: 1033696273
Provider Name (Legal Business Name): PRISCILLA JO JOHNSTON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9217 N HIGHWAY 59
CEDARVILLE AR
72932
US

IV. Provider business mailing address

101 W MAIN ST
HARDY AR
72542-9566
US

V. Phone/Fax

Practice location:
  • Phone: 870-895-2015
  • Fax: 870-895-2164
Mailing address:
  • Phone: 573-718-2570
  • Fax: 870-856-2133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberA005522
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberA005522
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: