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General NPI Number Information
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NPI Number | 1982020160
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Entity Type | Individual
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Provider Name | JESSICA L JOHNSON WHNP
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Gender | Female
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Dates
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Enumeration Date | 03/11/2014
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Last Update Date | 10/17/2019
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Provider Practice Location Address
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Address Line | 2240 COLISEUM DR SUITE B
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City | HAMPTON
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State | VA
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Zip | 23666-5903
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Country | US
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Telephone | 757-838-7277
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Fax | 757-838-8246
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Provider Business Mailing Address
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Address Line | 860 OMNI BLVD STE 101
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City | NEWPORT NEWS
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State | VA
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Zip | 23606-4430
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Country | US
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Telephone | 572-328-7697
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 0024171248
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License Number State | VA
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