MR. JERRY LYNN JOHNSTON (NPI# 1609849835) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609849835 |
| Entity Type | Individual |
| Full Name | MR. JERRY LYNN JOHNSTON |
| Credential | PA-C |
| Practice Address |
Womack Army Medical Center Mcxc-cod, Credentials Office, Attn: Sheila Blackwell Fort Bragg NC 28310-0001 |
| Mailing Address |
3865 Timberstream Dr Southport NC 28461-9023 |
| Practice Telephone | 9109078922 |
| Mailing Telephone | 9104548686 |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
104108 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962865691 | Jerry Lamar Johnston Jr. | Anesthesiology | 4301 W Markham St # 515, Little Rock, AR 72205-7101 | 2016-03-31 |
| Street Address |
WOMACK ARMY MEDICAL CENTER MCXC-COD, CREDENTIALS OFFICE, ATTN: SHEILA BLACKWELL |
| City | FORT BRAGG |
| State | NC |
| Zip Code | 28310-0001 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992288724 | Kabita Bista | Military Health Care Provider | Womack Army Medical Center, Fort Bragg, NC 28310-0001 | 2018-09-07 |
| 1841517638 | Samuel Neal Blacker | Anesthesiology | Womack Army Medical Center, Fort Bragg, NC 28310-3017 | 2010-05-03 |
| 1528233806 | Catherine Theresa Bush | Speech-Language Pathologist | Womack Army Medical Center, Fort Bragg, NC 28310 | 2008-04-28 |
| 1831362870 | Craig Edwards | Psychologist | Womack Army Medical Center, Department of Behavioral Health, Fort Bragg, NC 28310 | 2008-04-10 |
| 1497926042 | Melanie Nicole Leadley | Student in an Organized Health Care Education/Training Program | Womack Army Medical Center, Fort Bragg, NC 28310-0001 | 2008-03-21 |
| 1457547143 | Amanda Hammonds | Military Hospital | Womack Army Medical Center, Fort Bragg, NC 28310-0001 | 2007-09-17 |
| 1417996539 | Lynnette Clark | Audiologist | Womack Army Medical Center, Building 4-2817 Reilly Road, Fort Bragg, NC 28310-0001 | 2006-06-05 |
| 1841244688 | James Edward Czarnik | Emergency Medicine | Womack Army Medical Center, Fort Bragg, NC 28310 | 2006-05-19 |
| 1083671143 | Hillarie Ann Saul-rothman | Radiology | Womack Army Medical Center, 2817 Reilly Road, Fort Bragg, NC 28310-0001 | 2006-05-01 |
| 1225091994 | Sandra Moore Murrell | Physician Assistant | Womack Army Medical Center, Fort Bragg, NC 28310-0001 | 2006-04-11 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013550763 | Brent Francis Bachman | Physician Assistant | 2817 Reilly Street, Fort Bragg, NC 28310 | 2019-10-25 |
| 1417503459 | Cooper Pasque | Dentist | 1838 Normandy Dr., Fort Bragg, Apo, AA 28310 | 2019-08-15 |
| 1851959951 | Daniel Jordan Whitaker | Student in an Organized Health Care Education/Training Program | Womack Army Medical Center, 2817 Reilly Road, Mcxc-cod Credentials, Fort Bragg, NC 28310 | 2019-06-03 |
| 1679054217 | Christopher Cetnar | Dentist | Smokebomb Hill, Bldg 3718 Gruber Road, Fort Bragg, NC 28310 | 2018-08-22 |
| 1316427107 | Alexandrea Lee Clark | Dentist | Laflamme Dental Clinic, Bldg C6238 Ardennes Road, Fort Bragg, NC 28310 | 2018-08-21 |
| 1457843831 | Kevin Patrick Hudson | Student in an Organized Health Care Education/Training Program | 2817 Reilly Road Mxcx - Cod Credentials, Womack Army Medical Center, Fort Bragg, NC 28310 | 2018-06-01 |
| 1639691462 | Margaret S Greene | Dentist | Usa Dental Health Activity Fort Bragg, Wamc Box #151 2817 Rielly Rd, Fort Bragg, NC 28310 | 2017-07-13 |
| 1912432246 | Chezdan Baker | Student in an Organized Health Care Education/Training Program | Us Army Dental Health Activity Bldg-6837 Normandy Drive, Fort Bragg, NC 28310 | 2017-04-24 |
| 1215483094 | Shantryce Monique Boatwright Crump | Dental Hygienist | 2617 Rielly Road, Fort Bragg, NC 28310 | 2016-08-31 |
| 1629435714 | John Gagnier | Physician Assistant | Gruber Road, Building #c-1722, Fort Bragg, NC 28310 | 2016-01-21 |
| Find all providers in zip 28310 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316375421 | Stephen Witte | Physician Assistant | Gruber Rd Bldg C-1722, Fort Bragg, NC 28310-0001 | 2013-10-29 |
| 1619253523 | Kurt Kresta | Physician Assistant | 2817 Rielly Rd Mcxc-cod Credentials, Womack Army Medical Center, Fort Bragg, NC 28310 | 2011-10-25 |
| 1265740674 | Roger Leon Harrison | Physician Assistant | 2817 Reilly Road Mxcx-cod Credentials, Womack Army Medical Center, Fort Bragg, NC 28310 | 2010-09-20 |
| 1255651063 | Pamela R Koehler | Physician Assistant | 721a River Dr, Fort Bragg, CA 95437-5402 | 2010-06-03 |
| 1598891517 | Jeffrey Alan Weiss | Physician Assistant | Womack Army Hospital, Fort Bragg, NC 28304-0000 | 2007-02-26 |
| 1942386107 | Maureen Marnell Sevilla | Physician Assistant | Joel Health Clinic Src, Womack Army Medcen, Fort Bragg, NC 28310-0001 | 2006-10-31 |
| 1679660518 | Kane D Morgan | Physician Assistant | Reilly Rd Bldg 4-2817, Womack Army Medical Center, Fort Bragg, NC 28310-0001 | 2006-10-10 |
| 1609983360 | Wilda Ann Mccain | Physician Assistant | Womack Army Medical Center Physical Exams, Reilly Rd, Fort Bragg, NC 28310-0001 | 2006-08-25 |
| 1235171869 | Sherry Lynn Womack | Physician Assistant | M4861 Logistics Ave, Fort Bragg, NC 28310-0001 | 2006-06-11 |
| 1588625461 | Michael Douglas Newman | Physician Assistant | Clark Health Clinic, Womack Army Medical Center, Fort Bragg, NC 28310-0001 | 2006-03-30 |
| Find all providers in FORT BRAGG | ||||
| City | FORT BRAGG |
| Zip Code | 28310 |
Please comment or provide details below to improve the information on MR. JERRY LYNN JOHNSTON.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.