Healthcare Provider Details

I. General information

NPI: 1245164227
Provider Name (Legal Business Name): VERNERDEAN JENA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 GOETHALS DR STE F
RICHLAND WA
99352-3301
US

IV. Provider business mailing address

951 BRITTANY PARK DR APT 621
ANTIOCH TN
37013-6026
US

V. Phone/Fax

Practice location:
  • Phone: 509-942-3272
  • Fax:
Mailing address:
  • Phone: 912-660-2280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: