Provider Demographics
NPI:1659394492
Name:JOHNSTON, PHARON A (AP,RN)
Entity Type:Individual
Prefix:MS
First Name:PHARON
Middle Name:A
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:AP,RN
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Mailing Address - Street 1:1321 LADY STREET, FIRST FLOOR
Mailing Address - Street 2:PALMETTO HEALTH
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201
Mailing Address - Country:US
Mailing Address - Phone:803-296-2548
Mailing Address - Fax:803-296-2525
Practice Address - Street 1:1330 TAYLOR AT MARION STREET
Practice Address - Street 2:PALMETTO BAPTIST COUNSELING CENTER
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201
Practice Address - Country:US
Practice Address - Phone:803-296-2548
Practice Address - Fax:803-296-2525
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC1132364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult