Healthcare Provider Details

I. General information

NPI: 1508247461
Provider Name (Legal Business Name): JARED RICHARD JOHNSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1784 BROWNING WAY STE 120
ELKO NV
89801-8331
US

IV. Provider business mailing address

612 ABARR DR
SPRING CREEK NV
89815-7344
US

V. Phone/Fax

Practice location:
  • Phone: 775-738-2555
  • Fax:
Mailing address:
  • Phone: 775-385-8666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA0343
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: