Active NPI
Kristine M Johnston, PH.D.
- Clinical Psychologist
- San Antonio, TX
National Provider Identifier
1558422923
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 228590
- Practice address
- 130 Lewis Street
San Antonio, TX 78212-5538 - Phone
- (210) 829-7471
- Fax
- (210) 829-5398
- NPI assigned
- Dec 12, 2006
- Last updated
- Oct 1, 2019
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 228590 | TX | Primary |
| Forensic Psychologist | 103TF0200X | 228590 | TX |
Addresses
Primary practice location
130 Lewis Street
San Antonio, TX 78212-5538
Mailing address
130 Lewis Street
San Antonio, TX 78212-5538
Phone (210) 829-7471
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00F79C | Other | TX | MEDICARE |
| 0332306-01 | Medicaid | TX | |
| TXB154952 | Other | TX | MEDICARE |
Other names 1
- Dr. Kristine Johnston Gerwell
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 228590 | TX | MD | Forensic Psychologist |
| 22859 | TX | MD | Pediatric Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1569888000000",
"number": "1558422923",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 LEWIS STREET",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782125538",
"telephone_number": "210-829-7471",
"fax_number": "210-829-5398"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 LEWIS STREET",
"city": "SAN ANTONIO",
"state": "TX",
"postal_code": "782125538",
"telephone_number": "210-829-7471",
"fax_number": "210-829-5398"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSTON",
"first_name": "KRISTINE",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-12",
"last_updated": "2019-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TX",
"license": "228590",
"primary": true
},
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": "TX",
"license": "228590",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "00F79C",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0332306-01",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "TXB154952",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "KRISTINE",
"last_name": "GERWELL",
"middle_name": "JOHNSTON",
"prefix": "DR.",
"credential": "PH.D",
"code": "1",
"type": "Former Name"
}
]
}Other providers in San Antonio, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.