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NPI Code Detail

MEDICARE: JAELI JOHNSON

MEDICARE: JAELI 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1740119866
Entity Type Code : Individual
Provider Name (Legal Business Name) : JAELI JOHNSON
Provider Business Mailing Address
First Line : PO BOX 10267
Second Line :
City : CONWAY
State : AR
Zip : 72034-0003
Country : US
Telephone Number : 501-358-3565
Fax Number :
Provider Business Practice Location Address
First Line : 2017 E RACE AVE
Second Line :
City : SEARCY
State : AR
Zip : 72143-4725
Country : US
Telephone Number : 501-358-6535
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2026
Last Update Date : 05/15/2026

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Directions to “ JAELI JOHNSON ” Practice Location

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