Healthcare Provider Details

I. General information

NPI: 1619688637
Provider Name (Legal Business Name): SHEMEELA GAIL JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7485 OAKLEAF DR
BATON ROUGE LA
70812-3728
US

IV. Provider business mailing address

8040 STONESHIRE DR
BATON ROUGE LA
70818-5762
US

V. Phone/Fax

Practice location:
  • Phone: 225-930-5056
  • Fax: 225-930-5162
Mailing address:
  • Phone: 225-223-0365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCIT-6003
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN141382
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number245066
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: