Healthcare Provider Details

I. General information

NPI: 1467620955
Provider Name (Legal Business Name): JOYCE GUIDRY JOHNSON BSN,RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E STONER AVE
SHREVEPORT LA
71101-4243
US

IV. Provider business mailing address

627 VALLEY MILLS DR
ARLINGTON TX
76018-2295
US

V. Phone/Fax

Practice location:
  • Phone: 318-221-8411
  • Fax:
Mailing address:
  • Phone: 817-557-5147
  • Fax: 817-557-5147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN045224
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: