Individual
MS. KRISTIN KAY JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BS BC-HIS
Contact information
Practice address
1101 COLUMBUS AVE, GRAND HAVEN, MI 49417-1556
(616) 847-3144
(616) 847-8416
Mailing address
1101 COLUMBUS AVE, GRAND HAVEN, MI 49417-1556
(616) 847-3144
(616) 847-8416
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
3501003169
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
043596178
PPOM ID
MI
05
—
4379248
—
MI
01
—
540G003350
BCBS ID
MI
01
—
7312319
AETNA ID
MI
05
—
904379248
—
MI
05
—
904804496
—
MI
Enumeration date
01/10/2006
Last updated
06/14/2024
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