Individual provider Active NPI

Jeresha Johnson, RN

  • Registered Nurse
  • New Haven, CT
National Provider Identifier
1366325771
Registry record updated Jul 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
206618 Issued in CT
Practice address
54 E Ramsdell St
New Haven, CT 06515-1140
Phone
(203) 781-4600
NPI assigned
Jul 31, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 206618 CT Primary

Addresses

Primary practice location

54 E Ramsdell St
New Haven, CT 06515-1140

Mailing address

1 Long Wharf Dr
New Haven, CT 06511-5991
Phone (203) 781-4600

Other identifiers 4

IdentifierTypeStateIssuer
008042339MedicaidCT
008024427MedicaidCT
008109605MedicaidCT
008023170MedicaidCT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
206618CTMDRegistered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1753920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753920000000",
    "number": "1366325771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 LONG WHARF DR",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065115991",
            "telephone_number": "203-781-4600",
            "fax_number": "203-781-4624"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "54 E RAMSDELL ST",
            "city": "NEW HAVEN",
            "state": "CT",
            "postal_code": "065151140",
            "telephone_number": "203-781-4600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JERESHA",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-31",
        "last_updated": "2025-07-31",
        "certification_date": "2025-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CT",
            "license": "206618",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008042339",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008024427",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008109605",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008023170",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in New Haven, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.