Healthcare Provider Details

I. General information

NPI: 1417930652
Provider Name (Legal Business Name): KAY A JOHNSTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16461 DOMESTIC AVE
FORT MYERS FL
33912-6008
US

IV. Provider business mailing address

3123 GREEN MEADOW DRIVE
SAN ANGELO TX
76904-6977
US

V. Phone/Fax

Practice location:
  • Phone: 877-266-7768
  • Fax: 603-952-3900
Mailing address:
  • Phone: 325-944-3376
  • Fax: 325-944-3306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberK7307
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberME131008
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: