Individual
JAYDEN JACK JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
527 5TH AVE S APT F6, BROOKINGS, SD 57006-3340
(605) 924-0521
Mailing address
527 5TH AVE S APT F6, BROOKINGS, SD 57006-3340
(605) 924-0521
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
E3904089
—
171000000X
Military Health Care Provider
Primary
E3904089
—
Other
Enumeration date
07/12/2025
Last updated
07/12/2025
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