| Doctor Name: | MARK ELDON JOHNSTON |
| NPI Number: | 1144623455 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RN |
| License Number: | AP126856 |
| Business Practice Address: | 12412 Judson Rd Live Oak, TX - 782333255 |
| Business Phone Number: | 2107575300 |
| Business Fax Number: | 2107575186 |
| Mailing Address: | 12412 Judson Rd, LIVE OAK |
| State: | TX |
| Postal Code: | 782333255 |
| Phone Number: | 2107575300 |
| Fax Number: | 2107575186 |
| NPI Enumeration Date: | 09/30/2014 |
| NPI Last Update Date: | 02/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | AP126856 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |