Provider Demographics
NPI:1093455636
Name:JOHNSON, CHRISTY LEE
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:LEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:LEE
Other - Last Name:RALSTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:431 W SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:PRESTON
Mailing Address - State:IA
Mailing Address - Zip Code:52069-9701
Mailing Address - Country:US
Mailing Address - Phone:563-321-6039
Mailing Address - Fax:
Practice Address - Street 1:915 13TH AVE N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-5067
Practice Address - Country:US
Practice Address - Phone:563-243-2511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-31
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA121601363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant