Individual
JACKIE ANN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
627 SMITHVIEW DR, MARYVILLE, TN 37803-6100
(865) 380-4390
(865) 380-4396
Mailing address
DEPT 888182, KNOXVILLE, TN 37995-8182
(800) 355-3565
(423) 714-2355
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN69057
TN
Other
Enumeration date
10/19/2009
Last updated
10/19/2009
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