1447310438 NPI number — MISS VIRGINIA JOHNSTON FNP

Table of content: MISS VIRGINIA JOHNSTON FNP (NPI 1447310438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447310438 NPI number — MISS VIRGINIA JOHNSTON FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSTON
Provider First Name:
VIRGINIA
Provider Middle Name:
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447310438
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1209
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURRELLS INLET
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29576-1209
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-652-8220
Provider Business Mailing Address Fax Number:
843-520-8365

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4040 HIGHWAY 17
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
MURRELLS INLET
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29576-5098
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-652-8150
Provider Business Practice Location Address Fax Number:
843-652-8151
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  2320 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2320 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".




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