Individual
SAMANTHA JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
51 S BRIAN MICKELSEN PKWY, COTTONWOOD, AZ 86326-3610
(928) 639-8132
(866) 279-8919
Mailing address
1090 COMMERCE DR, PRESCOTT, AZ 86305-3700
(928) 583-1000
(866) 323-8458
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
6297
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
090822
—
AZ
Enumeration date
12/11/2015
Last updated
06/16/2016
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