MEDICARE: JENNIFER NICOLE JOHNSON CRT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	227800000X	Certified Respiratory Therapist	RCP-4100	AR

General Provider Information

NPI Number	:	1003302415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER NICOLE JOHNSON CRT

Provider Business Mailing Address
First Line	:	190 AVIATION PLZ STE A-D
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-5529
Country	:	US
Telephone Number	:	501-525-2770
Fax Number	:

Provider Business Practice Location Address
First Line	:	190 AVIATION PLAZA, SUITE D
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71913-7191
Country	:	US
Telephone Number	:	501-525-2770
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2018
Last Update Date	:	06/11/2019

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