Healthcare Provider Details

I. General information

NPI: 1902730153
Provider Name (Legal Business Name): JESSICA RENEE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 COHASSET RD STE 175
CHICO CA
95926-2460
US

IV. Provider business mailing address

101 AHWAHNEE CMNS APT 60
CHICO CA
95928-8436
US

V. Phone/Fax

Practice location:
  • Phone: 209-471-3898
  • Fax:
Mailing address:
  • Phone: 209-471-3898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95093648
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: