Provider Demographics
NPI:1124788955
Name:JOHNSTON, CODI VONNICE (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:CODI
Middle Name:VONNICE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:MISS
Other - First Name:CODI
Other - Middle Name:VONNICE
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17150 W ROYAL PALM RD
Mailing Address - Street 2:
Mailing Address - City:WADDELL
Mailing Address - State:AZ
Mailing Address - Zip Code:85355-7554
Mailing Address - Country:US
Mailing Address - Phone:623-755-0294
Mailing Address - Fax:
Practice Address - Street 1:500 W THOMAS RD STE 220
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4215
Practice Address - Country:US
Practice Address - Phone:602-887-5025
Practice Address - Fax:888-571-6435
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ265248363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily