Jessica Ann Johnson, RN
Individual provider Active NPI Registered Nurse · Crane, MO
NPI 1649983404 · NPPES record last updated Jan 5, 2023
Key facts
- NPI
- 1649983404
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 2019027467 (MO)
- Practice address
- 111 Elijah LN
Crane, MO 65633-9198 - Phone
- (417) 840-4563
- NPI assigned
- Dec 26, 2022
- 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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2019027467 | MO | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 2019027467 | MO | Yes |
Addresses
Primary practice location
111 Elijah LN
Crane, MO 65633-9198
Mailing address
111 Elijah LN
Crane, MO 65633-9198
Phone (417) 840-4563
Other providers in Crane, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 5, 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.