Basic Information
Provider Information
NPI: 1306233697
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JOHNSTON
FirstName: SHARON
MiddleName: OBRERO
NamePrefix:  
NameSuffix:  
Credential: FNP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 16107 KENSINGTON DR
Address2:  
City: SUGAR LAND
State: TX
PostalCode: 774794224
CountryCode: US
TelephoneNumber: 2817838162
FaxNumber:  
Practice Location
Address1: 4936 BEECHNUT ST
Address2:  
City: HOUSTON
State: TX
PostalCode: 770961605
CountryCode: US
TelephoneNumber: 2817838162
FaxNumber: 7134397995
Other Information
ProviderEnumerationDate: 04/24/2015
LastUpdateDate: 12/05/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAP130381TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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