Provider Demographics
NPI:1962285858
Name:JOHNS, WILTON EDWARD II
Entity type:Individual
Prefix:MR
First Name:WILTON
Middle Name:EDWARD
Last Name:JOHNS
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 LANCING DR APT 274
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-7550
Mailing Address - Country:US
Mailing Address - Phone:804-840-6779
Mailing Address - Fax:
Practice Address - Street 1:1160 MOOSE DR
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-4218
Practice Address - Country:US
Practice Address - Phone:540-381-3171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-15
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001260934163W00000X
VA0024189933363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse