Provider Demographics
NPI:1427286749
Name:JOHNSTON, SARA GAYNELL (PA-C)
Entity type:Individual
Prefix:MS
First Name:SARA
Middle Name:GAYNELL
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 SHOTWELL RD
Mailing Address - Street 2:106
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-5597
Mailing Address - Country:US
Mailing Address - Phone:919-359-3667
Mailing Address - Fax:
Practice Address - Street 1:935 SHOTWELL RD
Practice Address - Street 2:106
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-5597
Practice Address - Country:US
Practice Address - Phone:919-359-3667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-02944363A00000X
MDC0003991363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant