# JENNIFER MARIE-SMITH JOHNSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1679561096
- **Gender:** F
- **Credential:** PA-C

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | 5601003542 | MI | Yes |

## Other

- **Enumeration date:** 10/10/2005
- **Last updated:** 04/08/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1010145 | HEALTH ADVANTAGE PPO | — |
| 01 | — | 139492 | GREAT LAKES HEALTH PLAN | — |
| 01 | — | 256 | COMMUNITY CHOICE | MI |
| 01 | — | 2832651 | MOLINA HEALTH CARE | MI |
| 01 | — | 970024194 | RAILROAD MEDICARE | — |