Healthcare Provider Details

I. General information

NPI: 1447054499
Provider Name (Legal Business Name): AMY JOHNSTON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6845 ELM ST STE 708
MC LEAN VA
22101-3851
US

IV. Provider business mailing address

8151 LAKE RILLHURST RD
CULPEPER VA
22701-9763
US

V. Phone/Fax

Practice location:
  • Phone: 301-656-6398
  • Fax:
Mailing address:
  • Phone: 703-209-7146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024193105
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: