Provider Demographics
NPI:1699050583
Name:JOHNSTON, JESSICA M (RN,MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:M
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:RN,MSN, FNP-BC
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 1292
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443-1292
Mailing Address - Country:US
Mailing Address - Phone:970-668-5771
Mailing Address - Fax:
Practice Address - Street 1:360 PEAK ONE DR.
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-668-5771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO100032364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO144609OtherRN LICENSE
CO100032OtherN:SNP