Provider Demographics
NPI:1386133023
Name:JOHNSTON, JESSICA LEE ROCKHILL (CDM)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE ROCKHILL
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4154 KINGSTON DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4441
Mailing Address - Country:US
Mailing Address - Phone:907-223-9548
Mailing Address - Fax:
Practice Address - Street 1:4154 KINGSTON DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99504-4441
Practice Address - Country:US
Practice Address - Phone:907-223-9548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-08
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
AK130911176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula