# MRS. JACQUELINE MICHELLE JOHNSON

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1720579808
- **Gender:** F
- **Credential:** NP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WD0400X | Diabetes Educator Registered Nurse | 124618 | MO | — |
| 363LA2200X | Adult Health Nurse Practitioner | 2017040108 | MO | Yes |
| 363LG0600X | Gerontology Nurse Practitioner | 2017040108 | MO | — |

## Other

- **Enumeration date:** 05/23/2018
- **Last updated:** 08/08/2018