Provider Demographics
NPI:1548508302
Name:JOHNSON, JENNIFER LYNN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2018 PIN OAK TER
Mailing Address - Street 2:
Mailing Address - City:BONAIRE
Mailing Address - State:GA
Mailing Address - Zip Code:31005-2600
Mailing Address - Country:US
Mailing Address - Phone:478-320-2517
Mailing Address - Fax:478-328-2326
Practice Address - Street 1:915 ELMO ST
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3710
Practice Address - Country:US
Practice Address - Phone:229-389-2038
Practice Address - Fax:229-924-9899
Is Sole Proprietor?:No
Enumeration Date:2013-01-29
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN190791163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse