Individual
DESHAH JALEN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
833 WAKE FOREST BUSINESS PARK STE F, WAKE FOREST, NC 27587-7184
(919) 230-1419
Mailing address
200 PARK AT NORTH HILLS ST APT 1208, RALEIGH, NC 27609-2651
(910) 554-8203
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
5021005
NC
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
5021005
NC
Other
Enumeration date
10/12/2024
Last updated
10/12/2024
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