Provider Demographics
NPI:1184821274
Name:JOHNSTON, REBEKAH C (PA-C)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:C
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:REBEKAH
Other - Middle Name:C
Other - Last Name:HERTIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:720 SW LANE ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66606-1539
Mailing Address - Country:US
Mailing Address - Phone:785-270-4800
Mailing Address - Fax:
Practice Address - Street 1:720 SW LANE ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1539
Practice Address - Country:US
Practice Address - Phone:785-270-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2139-023363A00000X
WI2139023363AM0700X
KS15-01225363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS068002242OtherMEDICARE PTAN
KS200568000AMedicaid