Provider Demographics
NPI:1114308707
Name:JOHNSON, JESSICA JOANN (FNP - BC)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:JOANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP - BC
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:JOANN
Other - Last Name:STEVENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6924 GEYER SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-2728
Mailing Address - Country:US
Mailing Address - Phone:501-562-1463
Mailing Address - Fax:501-803-9991
Practice Address - Street 1:6924 GEYER SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-2728
Practice Address - Country:US
Practice Address - Phone:501-562-1463
Practice Address - Fax:501-803-9991
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004367363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily