Provider Demographics
NPI:1700801370
Name:JOHNSTEN, MARY E (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
Last Name:JOHNSTEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:HOFFMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:407 KUMQUAT ST
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-1246
Mailing Address - Country:US
Mailing Address - Phone:251-581-2445
Mailing Address - Fax:
Practice Address - Street 1:411 N SECTION ST
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532
Practice Address - Country:US
Practice Address - Phone:251-660-3470
Practice Address - Fax:251-660-3471
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2019-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA-393363AM0700X
FLPA9107082363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008087700Medicaid
AL51593935OtherBCBS - 1720 CENTER ST
AL51593844OtherBCBS - 575 STANTON RD
AL51593935OtherBCBS - 1720 CENTER ST
AL510I970122Medicare PIN