Healthcare Provider Details

I. General information

NPI: 1326549858
Provider Name (Legal Business Name): JOALEEN ROCHELLE JOHNSON RN, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 BUSINESS CENTER DR
FAIRFIELD CA
94534-1696
US

IV. Provider business mailing address

PO BOX 359 7421 BURNET ROAD
AUSTIN TX
78757-2244
US

V. Phone/Fax

Practice location:
  • Phone: 707-224-8266
  • Fax:
Mailing address:
  • Phone: 925-481-9219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number95139423
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95012753
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP950127
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: