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General NPI Number Information
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NPI Number | 1134482755
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Entity Type | Individual
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Provider Name | MATTHEW PHILIP JOHNSTON ARNP
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Gender | Male
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Dates
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Enumeration Date | 06/19/2012
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 1178 KINOOLE ST
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City | HILO
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State | HI
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Zip | 96720-7206
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Country | US
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Telephone | 83-338-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 75-5751 KUAKINI HWY STE 203
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City | KAILUA KONA
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State | HI
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Zip | 96740-1753
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Country | US
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Telephone | 808-333-3600
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Fax | 808-961-5167
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3007618
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 3540
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License Number State | HI
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