Healthcare Provider Details

I. General information

NPI: 1629945886
Provider Name (Legal Business Name): SARA JANE JOHNSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2025
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 N MOUNT OLIVE ST # 1
SILOAM SPRINGS AR
72761-9509
US

IV. Provider business mailing address

1500 N MOUNT OLIVE ST # 1
SILOAM SPRINGS AR
72761-9509
US

V. Phone/Fax

Practice location:
  • Phone: 855-438-2280
  • Fax:
Mailing address:
  • Phone: 855-438-2280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number235105
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: