Provider Demographics
NPI:1053483222
Name:JOHNSTON, KATHLEEN MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARIE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:KATHLEEN
Other - Middle Name:MARIE
Other - Last Name:BILLINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:20 POWEL AVENUE
Mailing Address - Street 2:COMPREHENSIVE SPINE CENTER, NEWPORT HOSPITAL
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840
Mailing Address - Country:US
Mailing Address - Phone:401-845-1190
Mailing Address - Fax:401-845-1073
Practice Address - Street 1:20 POWEL AVENUE
Practice Address - Street 2:COMPREHENSIVE SPINE CENTER, NEWPORT HOSPITAL
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840
Practice Address - Country:US
Practice Address - Phone:401-845-1190
Practice Address - Fax:401-845-1073
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052819363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant