Provider Demographics
NPI:1699928754
Name:JOHNSON, JEANANNE (APRN-BC, FNP , PMHNP)
Entity type:Individual
Prefix:
First Name:JEANANNE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN-BC, FNP , PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1358 S RIVER RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-4610
Mailing Address - Country:US
Mailing Address - Phone:180-166-9342
Mailing Address - Fax:
Practice Address - Street 1:1358 S RIVER RIDGE LN
Practice Address - Street 2:
Practice Address - City:SPANISH FORK
Practice Address - State:UT
Practice Address - Zip Code:84660-4610
Practice Address - Country:US
Practice Address - Phone:801-669-3425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-02
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6670082-4405363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily