Doctor Name: | MATTHEW PHILIP JOHNSTON |
NPI Number: | 1134482755 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | ARNP |
License Number: | 3007618 |
Business Practice Address: | 2100 N Main St Ste 1a Madisonville, KY - 424319007 |
Business Phone Number: | 2708216262 |
Business Fax Number: | 2708216272 |
Mailing Address: | 2100 N Main St Ste 1a, MADISONVILLE |
State: | KY |
Postal Code: | 424319007 |
Phone Number: | 2708216262 |
Fax Number: | 2708216272 |
NPI Enumeration Date: | 06/19/2012 |
NPI Last Update Date: | 08/19/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 3007618 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |