Healthcare Provider Details

I. General information

NPI: 1184107922
Provider Name (Legal Business Name): STEPHEN LEIGH JOHNSTON DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 SUSHRUTA DR STE A
MARTINSBURG WV
25401-8801
US

IV. Provider business mailing address

801 ENGLE SWITCH RD
HARPERS FERRY WV
25425-5257
US

V. Phone/Fax

Practice location:
  • Phone: 304-449-3778
  • Fax:
Mailing address:
  • Phone: 304-240-7813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN63221-FNP-BC
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: