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General NPI Number Information
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NPI Number | 1568508091
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Entity Type | Individual
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Provider Name | KEARY J JOHNSTON PA
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Gender | Female
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 08/12/2011
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Provider Practice Location Address
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Address Line | 1434 PORTER ST
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City | FORT DETRICK
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State | MD
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Zip | 21702-9254
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Country | US
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Telephone | 915-227-9515
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Fax | 915-569-1233
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Provider Business Mailing Address
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Address Line | 1434 PORTER ST
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City | FORT DETRICK
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State | MD
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Zip | 21702-9254
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Country | US
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Telephone | 915-227-9515
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Fax | 915-569-1233
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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 | 007117
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License Number State | NY
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