Provider Demographics
NPI:1558703967
Name:JOHNSTON, CARISSA K
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:K
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KC
Other - Middle Name:
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:601 CEDAR DR SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-7604
Mailing Address - Country:US
Mailing Address - Phone:206-963-6629
Mailing Address - Fax:
Practice Address - Street 1:601 CEDAR DR SE
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-7604
Practice Address - Country:US
Practice Address - Phone:206-963-6629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula