Provider Demographics
NPI:1982020160
Name:JOHNSON, JESSICA L (WHNP)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 OMNI BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4430
Mailing Address - Country:US
Mailing Address - Phone:572-328-7697
Mailing Address - Fax:
Practice Address - Street 1:2240 COLISEUM DR
Practice Address - Street 2:SUITE B
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5903
Practice Address - Country:US
Practice Address - Phone:757-838-7277
Practice Address - Fax:757-838-8246
Is Sole Proprietor?:No
Enumeration Date:2014-03-11
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171248363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024171248OtherLICENSE