Provider Demographics
NPI:1477661494
Name:JOHNSON, JERRY (PA)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:988095 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-8095
Mailing Address - Country:US
Mailing Address - Phone:402-559-9800
Mailing Address - Fax:402-559-9840
Practice Address - Street 1:988095 NEBRASKA MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-8095
Practice Address - Country:US
Practice Address - Phone:402-559-9800
Practice Address - Fax:402-559-9840
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant