Provider Demographics
NPI:1508104324
Name:JOHNSTON, EMILY KAY (PA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:KAY
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10E HOSPITAL ST
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-3153
Mailing Address - Country:US
Mailing Address - Phone:803-435-3131
Mailing Address - Fax:803-435-5288
Practice Address - Street 1:12409 W INDIAN SCHOOL RD
Practice Address - Street 2:BUILDING E
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-9502
Practice Address - Country:US
Practice Address - Phone:623-536-5353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5346363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant