Healthcare Provider Details

I. General information

NPI: 1306755244
Provider Name (Legal Business Name): JENNIFER JACKSON JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 N ELM ST
HIGH POINT NC
27262-3917
US

IV. Provider business mailing address

5306 NC HIGHWAY 55 STE 105
DURHAM NC
27713-7812
US

V. Phone/Fax

Practice location:
  • Phone: 336-885-0141
  • Fax:
Mailing address:
  • Phone: 337-408-0797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberJOHN-WSGO0
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: