Individual
JACK ALEXANDER JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1200 PLEASANT ST, DES MOINES, IA 50309-1406
(515) 241-6962
Mailing address
5032 WISTFUL VISTA DR, WEST DES MOINES, IA 50265-6922
(515) 783-5022
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
IA
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
12/07/2023
Last updated
04/11/2026
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