Individual
JACLYN A JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
4420 LAKE BOONE TRL, RALEIGH, NC 27607-7505
(919) 784-3100
Mailing address
124 E GATE CITY BLVD, GREENSBORO, NC 27406-1457
(336) 375-9232
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
7588
NC
390200000X
Student in an Organized Health Care Education/Training Program
—
NC
Other
Enumeration date
02/17/2023
Last updated
03/25/2025
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