Provider Demographics
NPI:1932091626
Name:JOHNSON, JEROME NATHANIEL (LPT)
Entity type:Individual
Prefix:MR
First Name:JEROME
Middle Name:NATHANIEL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:9301 JUNIPER LAKE ALY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95829-8746
Mailing Address - Country:US
Mailing Address - Phone:909-912-4631
Mailing Address - Fax:
Practice Address - Street 1:3331 POWER INN RD # 140
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3889
Practice Address - Country:US
Practice Address - Phone:916-875-1183
Practice Address - Fax:916-875-1190
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA42083167G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes167G00000XNursing Service ProvidersLicensed Psychiatric Technician