Provider Demographics
NPI:1407460413
Name:JOHNSTON, DEMETROUS (PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:DEMETROUS
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1242 CORKWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-5107
Mailing Address - Country:US
Mailing Address - Phone:757-214-7481
Mailing Address - Fax:
Practice Address - Street 1:809 KENT PL
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-0768
Practice Address - Country:US
Practice Address - Phone:757-436-0605
Practice Address - Fax:833-449-5172
Is Sole Proprietor?:No
Enumeration Date:2020-09-07
Last Update Date:2024-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024180054363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health