Provider Demographics
NPI:1629474135
Name:JOHNSTON, SOSSAN JAMILAH (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SOSSAN
Middle Name:JAMILAH
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16085 NW EDWARD CT
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-7209
Mailing Address - Country:US
Mailing Address - Phone:603-969-7197
Mailing Address - Fax:
Practice Address - Street 1:109 SW 366TH ST
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-7372
Practice Address - Country:US
Practice Address - Phone:603-969-7197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA60600188363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant