Healthcare Provider Details

I. General information

NPI: 1619687191
Provider Name (Legal Business Name): KEATON JAMES JOHNSTON DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2022
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 W PIERCE ST
CARLSBAD NM
88220-4013
US

IV. Provider business mailing address

1016 W PIERCE ST
CARLSBAD NM
88220-4013
US

V. Phone/Fax

Practice location:
  • Phone: 575-885-3445
  • Fax:
Mailing address:
  • Phone: 575-885-3445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD2026-0008
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: