=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821507492
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JILL M JOHNSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2017
-----------------------------------------------------
Last Update Date | 12/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 415 MAIN ST
-----------------------------------------------------
City | SUMMERSVILLE
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26651-1343
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-872-1663
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 32 PIONEER LN
-----------------------------------------------------
City | SUMMERSVILLE
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26651-1889
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 681-224-0660
-----------------------------------------------------
Fax | 304-718-5133
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | PMHNP71327WV
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------