| NPI | 1619342599 |
|---|---|
| Former Name | JESSICA L JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WV APRN82920) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: WV 82929) |
| Enumeration Date | 2015-12-03 |
| Last Update Date | 2020-06-10 |