Provider Demographics
NPI:1184697435
Name:JOHNSON, JESSICA L (APRN)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:ROSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:17445 ARBOR STREET
Mailing Address - Street 2:SUITE 310
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130
Mailing Address - Country:US
Mailing Address - Phone:531-444-1206
Mailing Address - Fax:402-445-7033
Practice Address - Street 1:7500 MERCY ROAD
Practice Address - Street 2:SUITE 1300
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124
Practice Address - Country:US
Practice Address - Phone:402-393-3110
Practice Address - Fax:402-393-4499
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110541363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P86714Medicare UPIN
NE279172Medicare ID - Type Unspecified