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General NPI Number Information
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NPI Number | 1508104324
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Entity Type | Individual
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Provider Name | EMILY KAY JOHNSTON PA
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Gender | Female
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Dates
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Enumeration Date | 01/29/2013
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Last Update Date | 12/21/2015
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Provider Practice Location Address
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Address Line | 12409 W INDIAN SCHOOL RD BUILDING E
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City | AVONDALE
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State | AZ
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Zip | 85392-9502
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Country | US
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Telephone | 623-536-5353
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Fax |
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Provider Business Mailing Address
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Address Line | 10E HOSPITAL ST
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City | MANNING
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State | SC
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Zip | 29102-3153
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Country | US
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Telephone | 803-435-3131
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Fax | 803-435-5288
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5346
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License Number State | AZ
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