Healthcare Provider Details

I. General information

NPI: 1962639260
Provider Name (Legal Business Name): EMILY JOAN JOHNSTON P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 10/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8825 BEE CAVES RD
AUSTIN TX
78746
US

IV. Provider business mailing address

3205 SILVERLEAF DRIVE
AUSTIN TX
78757
US

V. Phone/Fax

Practice location:
  • Phone: 512-328-3376
  • Fax: 512-306-0222
Mailing address:
  • Phone: 405-990-6630
  • Fax: 512-306-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA06132
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: