Provider Demographics
NPI:1114268638
Name:JOHNSTON, JENNIFER BEASLEY (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BEASLEY
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3805 CHEROKEE STREET
Mailing Address - Street 2:KENNESAW INTERNAL MEDICINE
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144
Mailing Address - Country:US
Mailing Address - Phone:770-426-5666
Mailing Address - Fax:770-426-6205
Practice Address - Street 1:3805 CHEROKEE STREET
Practice Address - Street 2:KENNESAW INTERNAL MEDICINE
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144
Practice Address - Country:US
Practice Address - Phone:770-426-5666
Practice Address - Fax:770-426-6205
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN215247363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily