Active NPI
Kimberley Ann Johnston, PA
- Physician Assistant
- Rochester, NY
National Provider Identifier
1063728301
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 006780-1
- Practice address
- 1425 Portland Ave
Rochester, NY 14621-3001 - Phone
- (585) 922-4000
- NPI assigned
- Aug 24, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 006780-1 | NY | Primary |
Addresses
Primary practice location
1425 Portland Ave
Rochester, NY 14621-3001
Mailing address
721 Mariner Cir
Webster, NY 14580-3908
Phone (585) 704-5469
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 006780-1 | NY | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282608000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282608000000",
"number": "1063728301",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "721 MARINER CIR",
"city": "WEBSTER",
"state": "NY",
"postal_code": "145803908",
"telephone_number": "585-704-5469"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1425 PORTLAND AVE",
"city": "ROCHESTER",
"state": "NY",
"postal_code": "146213001",
"telephone_number": "585-922-4000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSTON",
"first_name": "KIMBERLEY",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "PA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-08-24",
"last_updated": "2010-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "006780-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rochester, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.