MEDICARE: JASON RUSSELL JOHNSON ARNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP60642223	WA

General Provider Information

NPI Number	:	1568739100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON RUSSELL JOHNSON ARNP

Provider Business Mailing Address
First Line	:	677 WOODLAND SQUARE LOOP SE # B8
Second Line	:
City	:	LACEY
State	:	WA
Zip	:	98503-1000
Country	:	US
Telephone Number	:	360-623-4181
Fax Number	:	360-539-0972

Provider Business Practice Location Address
First Line	:	677 WOODLAND SQUARE LOOP SE # B8
Second Line	:
City	:	LACEY
State	:	WA
Zip	:	98503-1000
Country	:	US
Telephone Number	:	360-623-4181
Fax Number	:	360-539-0972

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

Provider Enumeration Date	:	11/28/2011
Last Update Date	:	05/18/2026

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