Provider Demographics
NPI:1134482755
Name:JOHNSTON, MATTHEW PHILIP (ARNP)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:PHILIP
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75-5751 KUAKINI HWY STE 203
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1753
Mailing Address - Country:US
Mailing Address - Phone:808-333-3600
Mailing Address - Fax:808-961-5167
Practice Address - Street 1:1178 KINOOLE ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-7206
Practice Address - Country:US
Practice Address - Phone:083-338-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007618363LF0000X
HI3540363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100215240Medicaid
KY000000781639OtherBCBS WALMART MILLE
KYP01105256OtherRR MEDICARE-BAPTIST HEALTH MADISONVILLE INC
KY000000781754OtherBCBS TROVER
HI3540OtherAPRN LICENSE
KYK054153Medicare PIN
KYK054152Medicare PIN
KY000000781754OtherBCBS TROVER
KYK054150Medicare PIN