Individual
JADE TAYLIR JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1111 MAIN ST, WAYNE, NE 68787-1181
(402) 375-7162
Mailing address
521 E 6TH ST, WAYNE, NE 68787-2210
(715) 566-3288
Taxonomy
Speciality
Code
Description
License number
State
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
777
NE
2083S0010X
Sports Medicine (Preventive Medicine) Physician
Primary
777
NE
Other
Enumeration date
11/28/2018
Last updated
11/28/2018
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