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General NPI Number Information
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NPI Number | 1932992443
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Entity Type | Individual
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Provider Name | JESSICA JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 1703 WENTWORTH AVE
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City | BEATRICE
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State | NE
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Zip | 68310-1348
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Country | US
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Telephone | 402-806-7467
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Fax |
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Provider Business Mailing Address
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Address Line | 502 W J ST
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City | WYMORE
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State | NE
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Zip | 68466-1026
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Country | US
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Telephone | 402-853-8044
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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 | 385HR2060X
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Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
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License Number |
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License Number State |
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