Provider Demographics
NPI:1902081789
Name:JOHNSTON, KRISTIN ERIN (CNM)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:ERIN
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 CARRIAGE HOUSE DR
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-9219
Mailing Address - Country:US
Mailing Address - Phone:612-605-4585
Mailing Address - Fax:
Practice Address - Street 1:100 CARRIAGE HOUSE DR
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-9219
Practice Address - Country:US
Practice Address - Phone:612-605-4585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-30
Last Update Date:2007-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165711367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife