Healthcare Provider Details

I. General information

NPI: 1770327926
Provider Name (Legal Business Name): JARISA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2024
Last Update Date: 06/22/2024
Certification Date: 06/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 SALEM TOWNE CT
APEX NC
27502-2311
US

IV. Provider business mailing address

707 EL IVES DR
ABERDEEN NC
28315-3620
US

V. Phone/Fax

Practice location:
  • Phone: 704-473-7738
  • Fax:
Mailing address:
  • Phone: 704-473-7738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: