Provider Demographics
NPI:1609671239
Name:JOHNSON, JESSICA L (LPN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 W ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68503-2738
Mailing Address - Country:US
Mailing Address - Phone:816-308-9050
Mailing Address - Fax:
Practice Address - Street 1:220 N 89TH ST STE 202
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-4072
Practice Address - Country:US
Practice Address - Phone:402-502-5750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE26891164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse