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General NPI Number Information
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NPI Number | 1336514645
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Entity Type | Individual
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Provider Name | SAMANTHA JOHNSTON PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/11/2015
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Last Update Date | 06/16/2016
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Provider Practice Location Address
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Address Line | 51 S BRIAN MICKELSEN PKWY
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City | COTTONWOOD
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State | AZ
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Zip | 86326-3610
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Country | US
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Telephone | 928-639-8132
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Fax | 866-279-8919
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Provider Business Mailing Address
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Address Line | 1090 COMMERCE DR
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City | PRESCOTT
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State | AZ
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Zip | 86305-3700
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Country | US
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Telephone | 928-583-1000
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Fax | 866-323-8458
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 6297
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License Number State | AZ
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