Healthcare Provider Details

I. General information

NPI: 1578387734
Provider Name (Legal Business Name): KRYSTAL JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 YORKTOWN DR STE A
ALEXANDRIA LA
71303-3673
US

IV. Provider business mailing address

109 YORKTOWN DR STE A
ALEXANDRIA LA
71303-3673
US

V. Phone/Fax

Practice location:
  • Phone: 318-542-4288
  • Fax: 318-704-6201
Mailing address:
  • Phone: 318-542-4288
  • Fax: 318-704-6201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19643
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: