Provider Demographics
NPI:1700929304
Name:JOHNSON, JEANA M (ARNP)
Entity type:Individual
Prefix:
First Name:JEANA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JEANA
Other - Middle Name:M
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:PO BOX 119
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:WA
Mailing Address - Zip Code:98944-0119
Mailing Address - Country:US
Mailing Address - Phone:509-837-3933
Mailing Address - Fax:509-837-3885
Practice Address - Street 1:1117 TIETON DRIVE
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902
Practice Address - Country:US
Practice Address - Phone:866-904-7721
Practice Address - Fax:509-925-6732
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006756363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9643925Medicaid
WAQ39362Medicare UPIN
Q39362Medicare UPIN