Jalisa Johnson
Individual provider Active NPI Home Health Agency · Lake, MS
NPI 1285340703 · NPPES record last updated Jan 27, 2023
Key facts
- NPI
- 1285340703
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Home Health Agency 251E00000X
- Practice address
- 249 Johnsontown Rd
Lake, MS 39092-3909 - Phone
- (769) 274-1148
- NPI assigned
- Jan 27, 2023
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Yes |
Addresses
Primary practice location
249 Johnsontown Rd
Lake, MS 39092-3909
Mailing address
249 Johnsontown Rd
Lake, MS 39092-9563
Phone (769) 274-1148
Other providers in Lake, MS
- Tamantha Harris
- Tina U. Mabry
- Danielle Parks
- Scott Regional Medical Center, Inc.
- Serenity and Grace, LLC
- Danielle Towner
All providers in Lake, MS · Home Health Agency in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 27, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.