Provider Demographics
NPI:1679810337
Name:JOHNSTON, CAROL B (APN)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:B
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 MCINTYRE ST
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80403-7445
Mailing Address - Country:US
Mailing Address - Phone:303-949-1250
Mailing Address - Fax:
Practice Address - Street 1:9195 GRANT ST STE 110
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4386
Practice Address - Country:US
Practice Address - Phone:720-536-2460
Practice Address - Fax:720-536-2466
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0990500363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO46324879Medicaid
CO276759YQPGOtherMEDICARE
CO276759YQ3LOtherMEDICARE
CO276759YQHJMedicare Oscar/Certification