Provider Demographics
NPI:1174948145
Name:JOHNSTON, ALEXANDER C (PMHNP)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:C
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-1601
Mailing Address - Country:US
Mailing Address - Phone:802-864-6309
Mailing Address - Fax:
Practice Address - Street 1:65 NORTHGATE PLAZA
Practice Address - Street 2:SUITE 11
Practice Address - City:MORRISVILLE
Practice Address - State:VT
Practice Address - Zip Code:05661-5900
Practice Address - Country:US
Practice Address - Phone:802-888-8320
Practice Address - Fax:802-888-8136
Is Sole Proprietor?:No
Enumeration Date:2014-02-26
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0101897363LP0808X
VT101-0101897363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health