Individual provider · Type 1 NPI
Jayden Jack Johnson
Military Health Care Provider · Brookings, SD
NPI number
1679464119
Active
Practice location
527 5th Ave S Apt F6
Brookings, SD 57006-3340
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Military Health Care Provider Primary | 171000000X | E3904089 |
| Basic Emergency Medical Technician | 146N00000X | E3904089 |
Military Health Care Provider: Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes.
About NPI 1679464119
Jayden Jack Johnson's National Provider Identifier is 1679464119, issued on Jul 12, 2025. The primary taxonomy on file is Military Health Care Provider (171000000X), and the practice location is in Brookings, SD. The record was last updated on Jul 12, 2025.