Provider Demographics
NPI:1730333964
Name:JOHNSTON, BRENDA J (NP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:J
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 TAVISTOCK DR
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602-2686
Mailing Address - Country:US
Mailing Address - Phone:540-303-2446
Mailing Address - Fax:
Practice Address - Street 1:333 W CORK ST STE 100
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3870
Practice Address - Country:US
Practice Address - Phone:540-536-0518
Practice Address - Fax:540-536-0249
Is Sole Proprietor?:No
Enumeration Date:2008-11-14
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167939363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1730333964Medicaid
VAMC12154Medicare PIN