Healthcare Provider Details

I. General information

NPI: 1306777628
Provider Name (Legal Business Name): JERSEE JOHNSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 4TH ST SE
HURON SD
57350-2509
US

IV. Provider business mailing address

111 4TH ST SE
HURON SD
57350-2509
US

V. Phone/Fax

Practice location:
  • Phone: 605-352-8691
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200784
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: