Provider Demographics
NPI:1568508091
Name:JOHNSTON, KEARY J (PA)
Entity type:Individual
Prefix:MS
First Name:KEARY
Middle Name:J
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1434 PORTER ST
Mailing Address - Street 2:
Mailing Address - City:FORT DETRICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-9254
Mailing Address - Country:US
Mailing Address - Phone:915-227-9515
Mailing Address - Fax:915-569-1233
Practice Address - Street 1:1434 PORTER ST
Practice Address - Street 2:
Practice Address - City:FORT DETRICK
Practice Address - State:MD
Practice Address - Zip Code:21702-9254
Practice Address - Country:US
Practice Address - Phone:915-227-9515
Practice Address - Fax:915-569-1233
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY007117363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant