MEDICARE: STONI LEE JOHNSTON APRN, MSN, PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	877514	TX
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP132208	TX

General Provider Information

NPI Number	:	1174073381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STONI LEE JOHNSTON APRN, MSN, PMHNP-BC

Provider Business Mailing Address
First Line	:	118 VINTAGE PARK BLVD STE W609
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-4095
Country	:	US
Telephone Number	:	281-747-8588
Fax Number	:	281-666-8880

Provider Business Practice Location Address
First Line	:	118 VINTAGE PARK BLVD STE W609
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77070-4095
Country	:	US
Telephone Number	:	281-747-8588
Fax Number	:	281-666-8880

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2016
Last Update Date	:	09/07/2022

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