Basic Information
| Provider Information | |||||||||
| NPI: | 1679810337 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSTON | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | B. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | APN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5920 MCINTYRE ST | ||||||||
| Address2: | |||||||||
| City: | GOLDEN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804037445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039491250 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9195 GRANT ST STE 110 | ||||||||
| Address2: | |||||||||
| City: | THORNTON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802294386 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7205362460 | ||||||||
| FaxNumber: | 7205362466 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2013 | ||||||||
| LastUpdateDate: | 06/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 0990500 | CO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 46324879 | 05 | CO | MEDICAID | 276759YQPG | 01 | CO | MEDICARE | OTHER | 276759YQ3L | 01 | CO | MEDICARE | OTHER |