Provider Demographics
NPI:1528566924
Name:JOHNSON, JESSICA RENEE (NP-C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RENEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19927 COUNTY ROAD 445
Mailing Address - Street 2:
Mailing Address - City:LINDALE
Mailing Address - State:TX
Mailing Address - Zip Code:75771-3500
Mailing Address - Country:US
Mailing Address - Phone:972-762-4538
Mailing Address - Fax:
Practice Address - Street 1:1379 BRAD CIR
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-6666
Practice Address - Country:US
Practice Address - Phone:903-881-5165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-31
Last Update Date:2018-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136374363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily