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General NPI Number Information
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NPI Number | 1447809280
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Entity Type | Individual
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Provider Name | REBECCA KAY JOHNSON AGNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/04/2019
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 1500 E WOODROW WILSON AVE
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City | JACKSON
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State | MS
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Zip | 39216-5116
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Country | US
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Telephone | 601-362-4471
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Fax |
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Provider Business Mailing Address
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Address Line | 8079 HARMONY RD
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City | CRYSTAL SPRINGS
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State | MS
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Zip | 39059-9249
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Country | US
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Telephone | 601-327-9088
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 903507
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 903507
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License Number State | MS
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