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NPI Code Detail

MEDICARE: KIMBERLI S JOHNSTON PA-C

MEDICARE: KIMBERLI S JOHNSTON 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
1363A00000XPhysician Assistant1707WI
2363A00000XPhysician AssistantPA9117536FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1932173895
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLI S JOHNSTON PA-C
Provider Business Mailing Address
First Line : PO BOX 102222
Second Line :
City : ATLANTA
State : GA
Zip : 30368-2222
Country : US
Telephone Number : 239-274-8200
Fax Number :
Provider Business Practice Location Address
First Line : 3730 7TH TER STE 101
Second Line :
City : VERO BEACH
State : FL
Zip : 32960-6556
Country : US
Telephone Number : 772-567-2332
Fax Number : 844-812-2806
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2006
Last Update Date : 09/12/2023

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Directions to “ KIMBERLI S JOHNSTON PA-C” Practice Location

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