Provider Demographics
NPI:1003376328
Name:JOHNSTON, COLTON KYLE (ACNPC-AG)
Entity Type:Individual
Prefix:MR
First Name:COLTON
Middle Name:KYLE
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 FRONT BEACH RD UNIT 6307
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32407-4286
Mailing Address - Country:US
Mailing Address - Phone:850-624-0880
Mailing Address - Fax:
Practice Address - Street 1:2202 STATE AVE STE 207
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4582
Practice Address - Country:US
Practice Address - Phone:850-872-3939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9343192163W00000X
FLAPRN11001964363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse