Provider Demographics
NPI:1528128907
Name:JOHNSTONE, KIMBERLYN ANN (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLYN
Middle Name:ANN
Last Name:JOHNSTONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 137
Mailing Address - Street 2:
Mailing Address - City:CHEWELAH
Mailing Address - State:WA
Mailing Address - Zip Code:99109-0137
Mailing Address - Country:US
Mailing Address - Phone:509-935-8711
Mailing Address - Fax:509-935-4882
Practice Address - Street 1:410 E KING ST
Practice Address - Street 2:
Practice Address - City:CHEWELAH
Practice Address - State:WA
Practice Address - Zip Code:99109-0137
Practice Address - Country:US
Practice Address - Phone:509-935-8711
Practice Address - Fax:509-935-4882
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00028861207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8129769Medicaid
WA35341OtherWA STATE L & I
WA35341OtherWA STATE L & I
WA8129769Medicaid
WAG000346402Medicare PIN