MEDICARE: VERNERDEAN JENA JOHNSON

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	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1245164227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERNERDEAN JENA JOHNSON

Provider Business Mailing Address
First Line	:	951 BRITTANY PARK DR APT 621
Second Line	:
City	:	ANTIOCH
State	:	TN
Zip	:	37013-6026
Country	:	US
Telephone Number	:	912-660-2280
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 GOETHALS DR STE F
Second Line	:
City	:	RICHLAND
State	:	WA
Zip	:	99352-3301
Country	:	US
Telephone Number	:	509-942-3272
Fax Number	:

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

Provider Enumeration Date	:	06/12/2026
Last Update Date	:	06/12/2026

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