Individual
JEANELLE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6379 CENTER DR, NORFOLK, VA 23502-4102
(757) 467-4200
Mailing address
204 W 22ND ST APT 109, NORFOLK, VA 23517-2208
(469) 585-7438
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110008662
VA
Other
Enumeration date
01/05/2022
Last updated
08/19/2022
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