IndividualActive
Jedidiah Johnson, HS1, IDC
NPI 1114000130 · Independent Duty Corpsman · Homer, AK
Provider details
- NPI number
- 1114000130
- Entity type
- Individual
- Primary specialty
- Independent Duty CorpsmanOther Service Providers
- Credential
- HS1, IDC
- Sex
- Male
- Sole proprietor
- No
Specialties & taxonomies
Other Service Providers
- Other Technician247200000X
Technologists, Technicians & Other Technical Service Providers
Practice location
4688 Homer Spit Rd
Homer, AK 99603-8001
Phone: (360) 567-8238
Approximate (ZIP-level) locationGet directions
Mailing address
4688 Homer Spit Rd
Homer, AK 99603
Registry dates
- Enumerated
- 2006-10-23
- Last updated
- 2013-10-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.