Healthcare Provider Details

I. General information

NPI: 1255242228
Provider Name (Legal Business Name): ANNA JOHNSTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3524 KALISTE SALOOM RD STE 401
LAFAYETTE LA
70508-7641
US

IV. Provider business mailing address

213 HARBOR BEND BLVD
LAFAYETTE LA
70508-4382
US

V. Phone/Fax

Practice location:
  • Phone: 337-806-9316
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number202059
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: