Provider Demographics
NPI:1326549858
Name:JOHNSON, JOALEEN ROCHELLE (RN, PMHNP)
Entity Type:Individual
Prefix:
First Name:JOALEEN
Middle Name:ROCHELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 359
Mailing Address - Street 2:7421 BURNET ROAD
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-2244
Mailing Address - Country:US
Mailing Address - Phone:925-481-9219
Mailing Address - Fax:
Practice Address - Street 1:4820 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94534-1696
Practice Address - Country:US
Practice Address - Phone:707-224-8266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95139423163WP0807X
CA95012753363L00000X
CANP950127363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner