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General NPI Number Information
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NPI Number | 1578951240
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Entity Type | Individual
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Provider Name | NICOLE LYNN JOHNSON CFNP
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Gender | Female
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Dates
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Enumeration Date | 01/05/2015
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Last Update Date | 10/22/2024
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Provider Practice Location Address
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Address Line | 3333 PONTCHARTRAIN DR
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City | SLIDELL
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State | LA
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Zip | 70458-4827
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Country | US
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Telephone | 985-238-0320
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Fax | 985-238-0321
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Provider Business Mailing Address
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Address Line | 600 JEFFERSON ST STE 600
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City | LAFAYETTE
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State | LA
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Zip | 70501-6987
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Country | US
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Telephone | 337-202-0720
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Fax | 337-465-4604
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R878829
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R878829
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 237427
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License Number State | LA
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