Healthcare Provider Details

I. General information

NPI: 1427329812
Provider Name (Legal Business Name): MS. KEISHAWN MARIE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2012
Last Update Date: 05/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 CHARLES DR
CHALMETTE LA
70043-3779
US

IV. Provider business mailing address

2626 CANAL ST STE 201
NEW ORLEANS LA
70119-6410
US

V. Phone/Fax

Practice location:
  • Phone: 504-237-6979
  • Fax:
Mailing address:
  • Phone: 504-237-6979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number8373
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: