Provider Demographics
NPI:1619502341
Name:JOHNSTON, SYDNEY MCKENNA (PA)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:MCKENNA
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:MCKENNA
Other - Last Name:PEAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:600 N COTNER BLVD STE 208
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505-2343
Mailing Address - Country:US
Mailing Address - Phone:402-464-5969
Mailing Address - Fax:402-464-3657
Practice Address - Street 1:600 N COTNER BLVD STE 208
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2343
Practice Address - Country:US
Practice Address - Phone:402-464-5969
Practice Address - Fax:402-464-3657
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2448363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant