MEDICARE: MRS. FELICIA JACKSON JOHNSON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA03197	TX
2	363AM0700X	Medical Physician Assistant	2491	AZ
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1699962548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. FELICIA JACKSON JOHNSON PA-C

Provider Business Mailing Address
First Line	:	8737 COLESVILLE RD STE 700
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-7901
Country	:	US
Telephone Number	:	240-269-6033
Fax Number	:

Provider Business Practice Location Address
First Line	:	8737 COLESVILLE RD STE 700
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-7901
Country	:	US
Telephone Number	:	240-269-6033
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2007
Last Update Date	:	01/23/2023

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