Individual
MS. JENNESSA R JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
806 W JACKSON ST, MUNCIE, IN 47305-1551
(765) 281-4263
(765) 286-1737
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
71003503A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201006660
—
IN
01
—
P01303727
RAILROAD MEDICARE
IN
Enumeration date
11/02/2010
Last updated
01/13/2021
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