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General NPI Number Information
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NPI Number | 1972201119
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Entity Type | Individual
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Provider Name | JACLYN A JOHNSON CRNA
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Gender | Female
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Dates
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Enumeration Date | 02/17/2023
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 4420 LAKE BOONE TRL
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City | RALEIGH
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State | NC
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Zip | 27607-7505
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Country | US
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Telephone | 919-784-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 124 E GATE CITY BLVD
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City | GREENSBORO
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State | NC
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Zip | 27406-1457
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Country | US
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Telephone | 336-375-9232
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 7588
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License Number State | NC
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