Provider Demographics
NPI:1912902990
Name:JOHNSTON, KRISTEN C (CPNP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:C
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:903 RUSSELL AVE
Mailing Address - Street 2:STE 301
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3257
Mailing Address - Country:US
Mailing Address - Phone:301-869-2292
Mailing Address - Fax:301-869-4223
Practice Address - Street 1:903 RUSSELL AVE
Practice Address - Street 2:STE 301
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3257
Practice Address - Country:US
Practice Address - Phone:301-869-2292
Practice Address - Fax:301-869-4223
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDR098339208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics