=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184696544
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BARBARA L JOHNSTON NP APN RN MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/01/2006
-----------------------------------------------------
Last Update Date | 09/08/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2338 N. VAN WINKLE WAY SUITE 2200
-----------------------------------------------------
City | PEORIA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61615
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-692-6088
-----------------------------------------------------
Fax | 309-692-0502
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 215 W STRATFORD DR
-----------------------------------------------------
City | PEORIA
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61614-7346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 309-472-6475
-----------------------------------------------------
Fax | 309-673-6914
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Nurse Practitioner
-----------------------------------------------------
License Number | 209005123
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------