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General NPI Number Information
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NPI Number | 1013737212
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Entity Type | Individual
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Provider Name | DESHAH JALEN JOHNSON NP
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Gender | Female
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Dates
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Enumeration Date | 10/12/2024
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Last Update Date | 10/12/2024
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Provider Practice Location Address
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Address Line | 833 WAKE FOREST BUSINESS PARK STE F
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City | WAKE FOREST
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State | NC
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Zip | 27587-7184
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Country | US
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Telephone | 919-230-1419
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Fax |
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Provider Business Mailing Address
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Address Line | 200 PARK AT NORTH HILLS ST APT 1208
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City | RALEIGH
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State | NC
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Zip | 27609-2651
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Country | US
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Telephone | 910-554-8203
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5021005
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 5021005
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License Number State | NC
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