Most Relevant Information
Provider Data
| NPI Number: | 1003486556 |
| Provider Name: | ILLISIA MARIE JOHNSTON NP-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | F06212134 |
Most Important Dates
| Enumeration Date: | 06/28/2021 |
| Last Updated: | 10/03/2024 |
Provider Practice Location
1008 N 15TH AVE
LAUREL
MS
394402656
Practice Location Phone/Fax
| Phone: | 6014265125 |
| Fax: |
Provider Mailing Location
PO BOX 247
LAUREL
MS
394410247
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |