Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jack Johnson

Individual provider Physician Assistant · NPI 1154075554

Jack Johnson is a Physician Assistant in Bastrop, Texas. Practices as a sole proprietor. Registered with an NPI since 2022.

In the registry since
2022

Practice location Address checks out

212 Creek Loop Rd
Bastrop, TX 78602-3197
Phone: (512) 988-6564
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X

Record details

NPI number1154075554
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedFebruary 5, 2022
Last updated in NPPESFebruary 5, 2022
Certification dateFebruary 5, 2022
Mailing address212 Creek Loop Rd, Bastrop, TX 78602-3197

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