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NPI Code Detail

MEDICARE: NICOLE LYNN JOHNSON CFNP

MEDICARE: NICOLE LYNN JOHNSON CFNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered NurseR878829MS
2363LF0000XFamily Nurse PractitionerR878829MS
3363LF0000XFamily Nurse Practitioner237427LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578951240
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE LYNN JOHNSON CFNP
Provider Business Mailing Address
First Line : 600 JEFFERSON ST STE 600
Second Line :
City : LAFAYETTE
State : LA
Zip : 70501-6987
Country : US
Telephone Number : 337-202-0720
Fax Number : 337-465-4604
Provider Business Practice Location Address
First Line : 3333 PONTCHARTRAIN DR
Second Line :
City : SLIDELL
State : LA
Zip : 70458-4827
Country : US
Telephone Number : 985-238-0320
Fax Number : 985-238-0321
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2015
Last Update Date : 10/22/2024

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