Provider Demographics
NPI:1033137237
Name:JOHNSON, JOCELYN O (APRN)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:O
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 N PLEASANT ST
Mailing Address - Street 2:SUITE 302B
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-1717
Mailing Address - Country:US
Mailing Address - Phone:413-253-2553
Mailing Address - Fax:413-253-2544
Practice Address - Street 1:96 N PLEASANT ST
Practice Address - Street 2:SUITE 302B
Practice Address - City:AMHERST
Practice Address - State:MA
Practice Address - Zip Code:01002-1717
Practice Address - Country:US
Practice Address - Phone:413-253-2553
Practice Address - Fax:413-253-2544
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA187677-PC363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1858734Medicaid
NS-0356Medicare UPIN
MA1858734Medicaid