Provider Demographics
NPI:1629676283
Name:JOHNSTON, JUSTON (FNP)
Entity type:Individual
Prefix:
First Name:JUSTON
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3154 FEDERAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80211-3745
Mailing Address - Country:US
Mailing Address - Phone:804-350-7966
Mailing Address - Fax:
Practice Address - Street 1:1900 WARDENBURG DRIVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80309-3047
Practice Address - Country:US
Practice Address - Phone:303-492-5101
Practice Address - Fax:303-492-6861
Is Sole Proprietor?:No
Enumeration Date:2020-10-15
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995855-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty