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General NPI Number Information
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NPI Number | 1730075144
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Entity Type | Individual
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Provider Name | SHAE ASHLEY JOHNSTON
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Gender |
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Dates
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Enumeration Date | 06/13/2025
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 4949 PROFESSIONAL PARK DR STE 101
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City | KANNAPOLIS
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State | NC
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Zip | 28081-8638
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Country | US
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Telephone | 704-938-6521
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Fax |
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Provider Business Mailing Address
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Address Line | 1750 CAMDEN RD APT 319
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City | CHARLOTTE
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State | NC
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Zip | 28203-6553
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Country | US
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Telephone | 912-506-1451
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Fax |
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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 | 001015594
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License Number State | NC
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