Provider Demographics
NPI:1013996958
Name:JOHNSTON, KRISTIN KAY (BS BC-HIS)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:KAY
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:BS BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1556
Mailing Address - Country:US
Mailing Address - Phone:616-847-3144
Mailing Address - Fax:616-847-8416
Practice Address - Street 1:1101 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-1556
Practice Address - Country:US
Practice Address - Phone:616-847-3144
Practice Address - Fax:616-847-8416
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI3501003169174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI904379248Medicaid
MI904804496Medicaid
MI540G003350OtherBCBS ID
MI7312319OtherAETNA ID
MI043596178OtherPPOM ID
MI4379248Medicaid
MI043596178OtherPRIORITY HEALTH ID