Provider Demographics
NPI:1962588384
Name:JOHNSON, JENNIFER COBB (RNCS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:COBB
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RNCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 OSPRAY ROAD
Mailing Address - Street 2:
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882-3408
Mailing Address - Country:US
Mailing Address - Phone:401-782-1026
Mailing Address - Fax:
Practice Address - Street 1:360 KINGSTOWN RD
Practice Address - Street 2:
Practice Address - City:NARRAGANSETT
Practice Address - State:RI
Practice Address - Zip Code:02882-3239
Practice Address - Country:US
Practice Address - Phone:401-789-9911
Practice Address - Fax:401-789-3106
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RINPP37087363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI24157-7OtherBLUE CROSS/BLUE SHIELD
RI407372OtherBLUECHIP
RINPP37087OtherNURSE PRACTITIONER LICENS
RINPP37087OtherNURSE PRACTITIONER LICENS
RI407372OtherBLUECHIP
RIMC0549874OtherDEA NUMBER