Healthcare Provider Details

I. General information

NPI: 1528991296
Provider Name (Legal Business Name): JASMINE MARIE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 1/2 W 20TH ST
SCOTTSBLUFF NE
69361-1908
US

IV. Provider business mailing address

422 1/2 W 20TH ST
SCOTTSBLUFF NE
69361-1908
US

V. Phone/Fax

Practice location:
  • Phone: 308-765-5913
  • Fax:
Mailing address:
  • Phone: 308-765-5913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: