Provider Demographics
NPI:1700992435
Name:JOHNSTON, CHERYL A (PA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26726
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-0726
Mailing Address - Country:US
Mailing Address - Phone:512-407-8686
Mailing Address - Fax:512-421-4489
Practice Address - Street 1:4101 JAMES CASEY #300
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1155
Practice Address - Country:US
Practice Address - Phone:512-383-9752
Practice Address - Fax:512-383-9296
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA00267363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181981501Medicaid
TX181981502Medicaid
TX970025377Medicaid
TX85N022Medicare PIN
TX8L19463Medicare PIN