Provider Demographics
NPI:1013286335
Name:JOHNSTON, JEREMY SCOTT (PA-C)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:SCOTT
Last Name:JOHNSTON
Suffix:
Gender:M
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 1:2852 WILLAMETTE ST STE 400
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-8200
Mailing Address - Country:US
Mailing Address - Phone:541-246-3400
Mailing Address - Fax:
Practice Address - Street 1:1605 OAK ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4022
Practice Address - Country:US
Practice Address - Phone:541-246-3400
Practice Address - Fax:541-246-3342
Is Sole Proprietor?:No
Enumeration Date:2011-12-14
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA168476208VP0000X, 208VP0014X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine