Healthcare Provider Details

I. General information

NPI: 1952052359
Provider Name (Legal Business Name): MORGAN JOHNSON MCCLELLAND DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2022
Last Update Date: 01/17/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 GRAMMONT ST
MONROE LA
71201-7457
US

IV. Provider business mailing address

309 JACKSON ST
MONROE LA
71201-7407
US

V. Phone/Fax

Practice location:
  • Phone: 318-388-4040
  • Fax:
Mailing address:
  • Phone: 318-966-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number223891
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: