Healthcare Provider Details

I. General information

NPI: 1467781757
Provider Name (Legal Business Name): LATASHA L JOHNIGAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6450 LOUISIANA HIGHWAY 1 SUITE B
INNIS LA
70747-0889
US

IV. Provider business mailing address

6450 LOUISIANA HIGHWAY 1
BATCHELOR LA
70715
US

V. Phone/Fax

Practice location:
  • Phone: 225-492-3775
  • Fax: 225-492-3782
Mailing address:
  • Phone: 225-492-3775
  • Fax: 225-492-3782

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberAP05967
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: