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General NPI Number Information
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NPI Number | 1205683869
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Entity Type | Individual
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Provider Name | JENNIFER MARIE JOHNSON FNP-C
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Gender | Female
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Dates
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Enumeration Date | 05/02/2024
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Last Update Date | 04/23/2025
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Provider Practice Location Address
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Address Line | PO BOX 507
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City | GARY
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State | WV
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Zip | 24836-0507
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Country | US
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Telephone | 304-448-2101
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Fax |
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Provider Business Mailing Address
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Address Line | 1675 STEWART ST
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City | WELCH
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State | WV
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Zip | 24801-2142
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Country | US
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Telephone | 304-888-0514
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 97296
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 119260
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License Number State | WV
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