Provider Demographics
NPI:1568722304
Name:JOHNSTON, LESLIE SARA (N P)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:SARA
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:N P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8601 HIGHWAY 217
Mailing Address - Street 2:
Mailing Address - City:MIRACLE
Mailing Address - State:KY
Mailing Address - Zip Code:40856-9096
Mailing Address - Country:US
Mailing Address - Phone:606-337-5150
Mailing Address - Fax:
Practice Address - Street 1:8601 HIGHWAY 217
Practice Address - Street 2:
Practice Address - City:MIRACLE
Practice Address - State:KY
Practice Address - Zip Code:40856-9096
Practice Address - Country:US
Practice Address - Phone:606-337-5150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-28
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007327171W00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No171W00000XOther Service ProvidersContractor