Provider Demographics
NPI:1700944246
Name:JOHNSON-SMITH, JEANNETTA (BSN, RN)
Entity Type:Individual
Prefix:MRS
First Name:JEANNETTA
Middle Name:
Last Name:JOHNSON-SMITH
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5021 CEDAR SANDS LN
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-1138
Mailing Address - Country:US
Mailing Address - Phone:915-821-6783
Mailing Address - Fax:
Practice Address - Street 1:10880 EDGEMERE BLVD
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-1306
Practice Address - Country:US
Practice Address - Phone:915-590-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX644766163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator