Healthcare Provider Details

I. General information

NPI: 1265285985
Provider Name (Legal Business Name): JESSICA MORGAN JOHNSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2024
Last Update Date: 10/31/2025
Certification Date: 10/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 BATH ST
SANTA BARBARA CA
93101-3403
US

IV. Provider business mailing address

1350 KELSO DUNES AVE APT 912
HENDERSON NV
89014-7855
US

V. Phone/Fax

Practice location:
  • Phone: 805-963-9377
  • Fax: 805-962-2154
Mailing address:
  • Phone: 443-895-0306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA65580
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: