Provider Demographics
NPI:1417930652
Name:JOHNSTON, KAY A (MD)
Entity Type:Individual
Prefix:DR
First Name:KAY
Middle Name:A
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3123 GREEN MEADOW DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-6977
Mailing Address - Country:US
Mailing Address - Phone:325-944-3376
Mailing Address - Fax:325-944-3306
Practice Address - Street 1:16461 DOMESTIC AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-6008
Practice Address - Country:US
Practice Address - Phone:877-266-7768
Practice Address - Fax:603-952-3900
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7307174400000X
FLME131008207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXZ000080R4Medicaid
TXG69326Medicare UPIN
TX00080RMedicare ID - Type Unspecified