Provider Demographics
NPI:1710504311
Name:JOHNSON, JESSICA LEE (ARNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE
Last Name:JOHNSON
Suffix:
Gender:
Credentials:ARNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 DEER PARK RD
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-7185
Mailing Address - Country:US
Mailing Address - Phone:425-400-8602
Mailing Address - Fax:425-433-9177
Practice Address - Street 1:132 DEER PARK RD
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-7185
Practice Address - Country:US
Practice Address - Phone:425-400-8602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1664699163W00000X
WARN60964516163W00000X
COAPN.0998411-NP363LP0808X
WAAP.61273054363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse