Individual
MR. JAKE WYATT JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
9888 WITTIG AVE, LAS VEGAS, NV 89149-1363
(623) 692-9633
Mailing address
9888 WITTIG AVE, LAS VEGAS, NV 89149-1363
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA3377
NV
Other
Enumeration date
12/26/2025
Last updated
12/26/2025
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