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General NPI Number Information
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NPI Number | 1215163498
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Entity Type | Individual
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Provider Name | MR. WALTER L JOHNSTON
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Gender | Male
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Dates
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Enumeration Date | 06/02/2009
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Last Update Date | 04/01/2014
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Provider Practice Location Address
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Address Line | 1008 N MAIN ST
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City | SIKESTON
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State | MO
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Zip | 63801-5044
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Country | US
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Telephone | 573-472-6003
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Fax | 573-472-6006
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Provider Business Mailing Address
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Address Line | 1008 N MAIN ST
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City | SIKESTON
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State | MO
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Zip | 63801-5044
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Country | US
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Telephone | 573-472-6003
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Fax | 573-472-6006
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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 | 2002018631
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License Number State | MO
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