Provider Demographics
NPI:1407226681
Name:JOHNSTON COLEMAN, JENNY (ARNP)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:JOHNSTON COLEMAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6928 47TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98516-2103
Mailing Address - Country:US
Mailing Address - Phone:206-617-8524
Mailing Address - Fax:
Practice Address - Street 1:1800 COOKS HILL RD STE F
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-9162
Practice Address - Country:US
Practice Address - Phone:360-669-0335
Practice Address - Fax:360-736-2967
Is Sole Proprietor?:No
Enumeration Date:2015-10-01
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60595033363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2048624Medicaid
WAG8946455Medicare PIN