Healthcare Provider Details

I. General information

NPI: 1447484613
Provider Name (Legal Business Name): TANIKA FRANK JOHNSON DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2009
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 DR MICHAEL DEBAKEY DR
LAKE CHARLES LA
70601-5724
US

IV. Provider business mailing address

501 DR MICHAEL DEBAKEY DR
LAKE CHARLES LA
70601-5724
US

V. Phone/Fax

Practice location:
  • Phone: 337-312-8462
  • Fax: 337-312-6720
Mailing address:
  • Phone: 337-312-8258
  • Fax: 337-312-6711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN108988-AP05783
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: