Provider Demographics
NPI:1518145044
Name:JOHNSTON, ANDREA P (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:P
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2200 E. PARRISH AVE
Mailing Address - Street 2:BLDG B, STE 101
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1449
Mailing Address - Country:US
Mailing Address - Phone:270-683-3232
Mailing Address - Fax:270-852-1600
Practice Address - Street 1:2200 E. PARRISH AVE
Practice Address - Street 2:BLDG B STE 101
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1449
Practice Address - Country:US
Practice Address - Phone:270-683-3232
Practice Address - Fax:270-852-1600
Is Sole Proprietor?:No
Enumeration Date:2008-02-06
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY41932208000000X
IN11012573A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY71-00046130OtherKENPAC
KY65939241Medicaid