Jenna Gabrielle Johnson, PSY D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY18496 Issued in CA

Practice address

230 S Shepherd St Ste D
Sonora, CA 95370-5076

Phone

(209) 432-3616

NPI assigned

Nov 19, 2005

Last updated

Dec 4, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jenna.johnson.p1@direct.mathiesenmemorialhc.nextgenshare.com
• Direct secure messaging: jenna.johnson.p3@direct.mathiesenmemorialhc.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mark Twain Medical Center

  • Critical Access Hospital
  • San Andreas, CA
  • NPI 1508968819
  NPD (past)
• Mathiesen Memorial Health Center

  • Primary Care Clinic/Center
  • Jamestown, CA
  • NPI 1356080022
  NPD (past)
• Sonora Community Hospital

  dba Groveland Family Medical Center

  • Family Medicine Physician
  • Groveland, CA
  • NPI 1356332274
  NPD (past)
• Tuolumne Mewuk Indian Health Center, Inc

  • Family Medicine Physician
  • Tuolumne, CA
  • NPI 1619952397
  NPD (past)

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

{
    "created_epoch": "1132358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701648000000",
    "number": "1710969191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 S SHEPHERD ST STE D",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953705076",
            "telephone_number": "209-432-3616",
            "fax_number": "209-694-4571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 S SHEPHERD ST STE D",
            "city": "SONORA",
            "state": "CA",
            "postal_code": "953705076",
            "telephone_number": "209-432-3616"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "51 Wellness Way",
            "address_purpose": "LOCATION",
            "city": "Valley Springs",
            "state": "CA",
            "postal_code": "952529736",
            "country_code": "US",
            "telephone_number": "209-772-7070",
            "fax_number": "209-772-1011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JENNA",
        "middle_name": "GABRIELLE",
        "credential": "PSY D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-11-19",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY18496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffery W Smith DDS Inc
• Jason Robert Jeffery, M.D.
• Brian Jensen, PH.D.
• Steve Christian Jensen, DPM
• Aimee Johnson
• Sharon Rose Johnson, M.D.
• Christopher Lee Jones, M.D.
• Julie Kathleen Jones, RNFA
• Steven Martin Joye, DO
• Justin P Liggett DDS Inc

• Clinical Psychologist in Sonora, CA
• Providers in Sonora, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.