Provider Demographics
NPI:1982940680
Name:JOHNSTON, KRYSTAL LYNN (RN)
Entity type:Individual
Prefix:MRS
First Name:KRYSTAL
Middle Name:LYNN
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:KRYSTAL
Other - Middle Name:LYNN
Other - Last Name:KOLLN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1708 E 44TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98404-4611
Mailing Address - Country:US
Mailing Address - Phone:253-471-4553
Mailing Address - Fax:253-722-2184
Practice Address - Street 1:1708 E 44TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98404
Practice Address - Country:US
Practice Address - Phone:253-471-4553
Practice Address - Fax:253-722-2184
Is Sole Proprietor?:No
Enumeration Date:2012-12-27
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60153474163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health