Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | A005522 | AR |
Y | 363LG0600X | Nurse Practitioner - Gerontology | A005522 | AR |
NPI | 1033696273 |
---|---|
Provider Name | Priscilla Jo Johnston |
First Address | Hardy, AR 72542-9566 |
Second Address | Cedarville, AR 72932 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/07/2018 |
Last Update Date | 22/08/2018 |