Individual
JACQUELINE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8955 W 400 N, MICHIGAN CITY, IN 46360-9330
(219) 861-5800
(219) 861-5543
Mailing address
PO BOX 781076, DETROIT, MI 48278-1008
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10005083A
IN
363A00000X
Physician Assistant
PA22120
CA
Other
Enumeration date
03/28/2012
Last updated
01/09/2026
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