Healthcare Provider Details

I. General information

NPI: 1992393748
Provider Name (Legal Business Name): KAREN JOHNSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31044 N CAFELINE RD
TICKFAW LA
70466-4006
US

IV. Provider business mailing address

PO BOX 1480
ALBANY LA
70711-1480
US

V. Phone/Fax

Practice location:
  • Phone: 985-634-2370
  • Fax:
Mailing address:
  • Phone: 985-634-2370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN118032
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: