Johnston, Walter L
Johnston, Walter L is an individual health care provider with primary practice located at 1008 N Main St , Sikeston MO 63801-5044. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as his primary health care specialty. Johnston, Walter L can be contacted via phone (573) 472-6003.Contact Information
Primary practice address
1008 N Main St
Sikeston MO 63801-5044
Phone: (573) 472-6003
Fax: (573) 472-6006
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | 2002018631 | Missouri |
Profile Details
| NPI number | 1215163498 |
|---|---|
| LBN Legal business name | Johnston, Walter L |
| Credentials | |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 2nd, 2009 |
| Last updated | Apr 1st, 2014 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1215163498 | NPPES |
| Missouri | MEDICAID | 1215163498 | |
| Missouri | Other | A03110 | |
| Missouri | Other | 177521 | |
| Missouri | MEDICAID | 1215163498 | |
| Missouri | Other | 1215163498 |
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