Healthcare Provider Details

I. General information

NPI: 1083640908
Provider Name (Legal Business Name): MEREDITH V JOHNSON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 05/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 COURT ST
PORT ALLEN LA
70767-2635
US

IV. Provider business mailing address

PO BOX 395
CLINTON LA
70722-0395
US

V. Phone/Fax

Practice location:
  • Phone: 225-389-1311
  • Fax: 225-389-1330
Mailing address:
  • Phone: 225-683-5292
  • Fax: 225-683-3411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number29873
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: