Individual
CALLYSTA JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4949 S HILLSDALE AVE, MERIDIAN, ID 83642-7586
(208) 706-6400
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 381-8752
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-2118
ID
Other
Enumeration date
10/28/2021
Last updated
06/07/2023
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