Provider Demographics
NPI:1205124716
Name:JOHNSTON, KELLY NAPIER (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:NAPIER
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KELLY
Other - Middle Name:ELIZABETH
Other - Last Name:NAPIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:15 OLD HUMBOLDT RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-3506
Mailing Address - Country:US
Mailing Address - Phone:901-624-3333
Mailing Address - Fax:731-240-1415
Practice Address - Street 1:701 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:TN
Practice Address - Zip Code:38343-3034
Practice Address - Country:US
Practice Address - Phone:731-784-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1695363AM0700X
TN1989363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical