Healthcare Provider Details

I. General information

NPI: 1598915563
Provider Name (Legal Business Name): JESSICA JOHNSON-CAMERON ANESTHESIOLOGIST ASS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2008
Last Update Date: 03/02/2026
Certification Date: 03/02/2026
Deactivation Date: 07/14/2021
Reactivation Date: 09/07/2021

III. Provider practice location address

1400 E BOULDER ST STE 1183
COLORADO SPRINGS CO
80909-5533
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-6999
  • Fax: 719-365-2837
Mailing address:
  • Phone: 970-624-4034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number67.000368
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberANT.0000334
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: