Provider Demographics
NPI:1073142097
Name:JOHNSTONE, KELSEY L
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:L
Last Name:JOHNSTONE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHWICK
Mailing Address - State:MA
Mailing Address - Zip Code:01077-9685
Mailing Address - Country:US
Mailing Address - Phone:413-579-7309
Mailing Address - Fax:
Practice Address - Street 1:266 HILLSIDE RD
Practice Address - Street 2:
Practice Address - City:SOUTHWICK
Practice Address - State:MA
Practice Address - Zip Code:01077-9685
Practice Address - Country:US
Practice Address - Phone:413-579-7309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-02
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program