Provider Demographics
NPI:1275024309
Name:JOHNSTON, AMY WALKER (IBCLC)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:WALKER
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5378 FLORENCE POINT DR
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-5409
Mailing Address - Country:US
Mailing Address - Phone:919-608-6533
Mailing Address - Fax:
Practice Address - Street 1:1886 S 14TH ST STE 6
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4719
Practice Address - Country:US
Practice Address - Phone:904-321-9089
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL-113871174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN