Provider Demographics
NPI:1477894186
Name:JOHNSTON, JEFFREY N (PA)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:N
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6620 MAIN STREET
Mailing Address - Street 2:13TH FLOOR
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2332
Mailing Address - Country:US
Mailing Address - Phone:713-986-6221
Mailing Address - Fax:
Practice Address - Street 1:6620 MAIN STREET
Practice Address - Street 2:13TH FLOOR
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2332
Practice Address - Country:US
Practice Address - Phone:713-986-6221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-05
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2508363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant