Healthcare Provider Details

I. General information

NPI: 1962327635
Provider Name (Legal Business Name): DARA JOHNSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 WILDCAT RD SWAN VALLEY, ID 83449
SWAN VALLEY ID
83449
US

IV. Provider business mailing address

PO BOX 274
SWAN VALLEY ID
83449-0274
US

V. Phone/Fax

Practice location:
  • Phone: 972-757-3132
  • Fax:
Mailing address:
  • Phone: 972-757-3132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number5681112
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: