Provider Demographics
NPI:1750462131
Name:JOHNSTONE, THOMAS K (PA)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:K
Last Name:JOHNSTONE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 NC 65 HWY
Mailing Address - Street 2:
Mailing Address - City:WENTWORTH
Mailing Address - State:NC
Mailing Address - Zip Code:27375
Mailing Address - Country:US
Mailing Address - Phone:336-342-8140
Mailing Address - Fax:
Practice Address - Street 1:371 NC 65 HWY
Practice Address - Street 2:
Practice Address - City:WENTWORTH
Practice Address - State:NC
Practice Address - Zip Code:27375
Practice Address - Country:US
Practice Address - Phone:336-342-8140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100177363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC21511OtherREGISTRATION NUMBER
NC100177OtherLICENSE