| Mr Walter L Johnston, | |
|
1008 N Main St, Sikeston, MO 63801-5044 | |
| (573) 472-6003 | |
| (573) 472-6006 |
| Full Name | Mr Walter L Johnston |
|---|---|
| Gender | Male |
| Speciality | Nurse Practitioner - Family |
| Location | 1008 N Main St, Sikeston, Missouri |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215163498 | NPI | - | NPPES |
| 1215163498 | Medicaid | MO | |
| A03110 | Other | MO | HEALTHLINK |
| 177521 | Other | MO | HEALTH ALLIANCE |
| 1215163498 | Medicaid | IL | |
| 1215163498 | Other | MO | TRIWEST |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363LF0000X | Nurse Practitioner - Family | 2002018631 (Missouri) | Primary |
| Entity Name | Missouri Delta Medical Center |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1508967860 PECOS PAC ID: 1355252891 Enrollment ID: O20040308001306 |
| Mailing Address | Practice Location Address |
|---|---|
| Mr Walter L Johnston, 1008 N Main St, Sikeston, MO 63801-5044 Ph: (573) 472-6003 | Mr Walter L Johnston, 1008 N Main St, Sikeston, MO 63801-5044 Ph: (573) 472-6003 |
Brittany Lynn Delaughter, FNP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1012 N Main St, Sikeston, MO 63801 Phone: 573-471-0330 Fax: 573-471-0461 | |
Erica Leigh Wilson, APRN, FNP-BC Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1008 N Main St, Sikeston, MO 63801 Phone: 573-472-7275 | |
Brittney Joy Dirnberger, FNP-C Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 135 Plaza Dr Ste 102, Sikeston, MO 63801 Phone: 573-472-6010 Fax: 573-472-6009 | |
Danielle E Jansen, FNP Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 200 Southland Dr, Sikeston, MO 63801 Phone: 573-472-1770 Fax: 573-472-1560 | |
Lauren Ashley Bissonnette, RN, FNP-BC Nurse Practitioner Medicare: Not Enrolled in Medicare Practice Location: 1012 N Main St, Sikeston, MO 63801 Phone: 573-481-5017 | |
Kelly Ann Jackson, FNP-BC Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1012 N Main St, Sikeston, MO 63801 Phone: 573-471-0330 Fax: 573-471-0461 | |
Margaret Rachel Coppage, FNP Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 1008 N Main St, Sikeston, MO 63801 Phone: 573-472-6001 Fax: 573-472-6006 |