Healthcare Provider Details

I. General information

NPI: 1134482755
Provider Name (Legal Business Name): MATTHEW PHILIP JOHNSTON ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2012
Last Update Date: 07/18/2022
Certification Date: 07/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1178 KINOOLE ST
HILO HI
96720-7206
US

IV. Provider business mailing address

75-5751 KUAKINI HWY STE 203
KAILUA KONA HI
96740-1753
US

V. Phone/Fax

Practice location:
  • Phone: 83-338-3600
  • Fax:
Mailing address:
  • Phone: 808-333-3600
  • Fax: 808-961-5167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3007618
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number3540
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: