MEDICARE: SARA JANE JOHNSON APRN

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	363LF0000X	Family Nurse Practitioner	235105	AR

General Provider Information

NPI Number	:	1629945886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA JANE JOHNSON APRN

Provider Business Mailing Address
First Line	:	1500 N MOUNT OLIVE ST # 1
Second Line	:
City	:	SILOAM SPRINGS
State	:	AR
Zip	:	72761-9509
Country	:	US
Telephone Number	:	855-438-2280
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 N MOUNT OLIVE ST # 1
Second Line	:
City	:	SILOAM SPRINGS
State	:	AR
Zip	:	72761-9509
Country	:	US
Telephone Number	:	855-438-2280
Fax Number	:

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

Provider Enumeration Date	:	10/22/2025
Last Update Date	:	03/06/2026

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