Healthcare Provider Details

I. General information

NPI: 1215544804
Provider Name (Legal Business Name): JARMAINE KELLY JOHNS NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 06/30/2025
Certification Date: 06/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1306 E ANAHEIM ST
LONG BEACH CA
90813
US

IV. Provider business mailing address

317 E SMITH ST
LONG BEACH CA
90805-2918
US

V. Phone/Fax

Practice location:
  • Phone: 562-270-0324
  • Fax:
Mailing address:
  • Phone: 310-714-4648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95015410
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: