Healthcare Provider Details

I. General information

NPI: 1013520774
Provider Name (Legal Business Name): MYISHA SANAE JOHNSON-LEDET FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MYISHA SANAE JOHNSON FNP-C

II. Dates (important events)

Enumeration Date: 08/24/2020
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4906 AMBASSADOR CAFFERY PKWY STE 200
LAFAYETTE LA
70508-6962
US

IV. Provider business mailing address

124 OAK COULEE DR
LAFAYETTE LA
70507-4816
US

V. Phone/Fax

Practice location:
  • Phone: 337-504-9707
  • Fax: 337-901-5822
Mailing address:
  • Phone: 337-315-7676
  • Fax: 337-901-5822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number214076
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: