MEDICARE: KEITH ALLAN JOHNSON PA-C

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	363A00000X	Physician Assistant	MA003170L	PA
2	363AM0700X	Medical Physician Assistant	MA003170L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00214218	OTHER	PA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50012614	OTHER	PA	CAPITAL BLUE CROSS

General Provider Information

NPI Number	:	1902829583
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH ALLAN JOHNSON PA-C

Provider Business Mailing Address
First Line	:	601 MEMORY LN
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-2231
Country	:	US
Telephone Number	:	717-851-1405
Fax Number	:

Provider Business Practice Location Address
First Line	:	7055 WESTBRANCH HWY
Second Line	:
City	:	LEWISBURG
State	:	PA
Zip	:	17837-6808
Country	:	US
Telephone Number	:	570-524-4141
Fax Number	:	570-524-5218

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

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	01/21/2026

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Directions to “ KEITH ALLAN JOHNSON PA-C” Practice Location

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