Healthcare Provider Details

I. General information

NPI: 1679956080
Provider Name (Legal Business Name): JESSICA LYNN JOHNS M.ED., LAT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2015
Last Update Date: 07/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 LAKEVIEW DRIVE
LORETTO PA
15940
US

IV. Provider business mailing address

408 W HORNER ST APT 21
EBENSBURG PA
15931-1350
US

V. Phone/Fax

Practice location:
  • Phone: 814-472-3317
  • Fax:
Mailing address:
  • Phone: 412-726-1223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberRT005649
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: