Healthcare Provider Details

I. General information

NPI: 1306765557
Provider Name (Legal Business Name): JENNIFER LYNN JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VANTAGE WAY STE E130
NASHVILLE TN
37228-1591
US

IV. Provider business mailing address

1 VANTAGE WAY STE E130
NASHVILLE TN
37228-1591
US

V. Phone/Fax

Practice location:
  • Phone: 615-988-4763
  • Fax:
Mailing address:
  • Phone: 615-988-4763
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: