Provider Demographics
NPI:1376944702
Name:JOHNSTON, NICHOLAS (MSN, PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1706
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-0029
Mailing Address - Country:US
Mailing Address - Phone:978-494-0175
Mailing Address - Fax:978-662-5291
Practice Address - Street 1:269 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3008
Practice Address - Country:US
Practice Address - Phone:978-494-0175
Practice Address - Fax:978-662-5291
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2262099363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health