Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mrs. Jacqueline S Johanson, PA-C

Individual provider Physician Assistant · NPI 1952304982

Mrs. Jacqueline S Johanson, PA-C is a Physician Assistant in Grand Rapids, Michigan. Graduated from Emory University School of Medicine in 2004, 22 years ago. Practices with Advantage Health/Saint Mary's Medical Group, a 494-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in Michigan.

Years since qualifying
22
Trained at
Emory University School of Medicine
Licensed in
MI
In the registry since
2005
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

310 Lafayette Ave SE Ste 410
Grand Rapids, MI 49503-4693
Phone: (616) 685-8200
Fax: (616) 685-8202
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 230 Michigan St Ne Ste 230, Grand Rapids, MI 49503-1709 — (404) 355-3161

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5601008301 (MI)

Record details

NPI number1952304982
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedMay 23, 2005
Last updated in NPPESDecember 28, 2021
Certification dateDecember 28, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolEMORY UNIVERSITY SCHOOL OF MEDICINE
Graduated 2004 (22 years in practice)
Group practice Advantage Health/Saint Mary'S Medical Group — 494 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

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