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Individual

KRISTEN ELIZABETH JOHNSTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
IDC

Contact information

Practice address
5502 MARVIN SHIELDS BLVD, GULFPORT, MS 39501
(228) 822-5922
Mailing address
159 BRENTWOOD BLVD, GULFPORT, MS 39503-4026
(619) 952-5756

Taxonomy

Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
1700469095
CA

Other

Enumeration date
05/04/2021
Last updated
12/02/2022
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