Individual
KEITON JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3425 POTOMAC WAY, IDAHO FALLS, ID 83404-4984
(208) 528-8170
Mailing address
3425 POTOMAC WAY, IDAHO FALLS, ID 83404-4984
(208) 528-8170
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
PA-1920
ID
Other
Enumeration date
08/21/2020
Last updated
05/24/2023
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