Provider Demographics
NPI:1457550907
Name:JOHNSTON, KRIS (DACM, AGPC-NP)
Entity Type:Individual
Prefix:DR
First Name:KRIS
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:DACM, AGPC-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 UNION BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-7952
Mailing Address - Country:US
Mailing Address - Phone:631-675-9000
Mailing Address - Fax:631-675-9002
Practice Address - Street 1:28 JONES ST
Practice Address - Street 2:SUITE 101
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-2941
Practice Address - Country:US
Practice Address - Phone:631-675-9000
Practice Address - Fax:631-675-9002
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-15
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003434171100000X
NY309251363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No171100000XOther Service ProvidersAcupuncturist