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Individual

KEVIN W JOHNSTON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
NP

Contact information

Practice address
33 TIMBERCREST LN, SOUTH SETAUKET, NY 11720-1243
(631) 922-5900
(631) 675-9002
Mailing address
33 TIMBERCREST LN, SOUTH SETAUKET, NY 11720-1243
(631) 922-5900
(631) 675-9002

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
689209
NY
363LA2200X
Adult Health Nurse Practitioner
Primary
F309196
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
F309196
NY STATE OFFICE OF PROFESSIONS
NY
Enumeration date
12/04/2014
Last updated
12/03/2019
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