Provider Demographics
NPI:1184696544
Name:JOHNSTON, BARBARA L (NP APN RN MS)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:L
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:NP APN RN MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W STRATFORD DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-7346
Mailing Address - Country:US
Mailing Address - Phone:309-472-6475
Mailing Address - Fax:309-673-6914
Practice Address - Street 1:2338 N. VAN WINKLE WAY
Practice Address - Street 2:SUITE 2200
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615
Practice Address - Country:US
Practice Address - Phone:309-692-6088
Practice Address - Fax:309-692-0502
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209005123363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209005123OtherAPN LICENSE