=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619239373
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TINA DIANE JOHNSON FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/08/2012
-----------------------------------------------------
Last Update Date | 01/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3194 HIGHWAY 71
-----------------------------------------------------
City | CAMPTI
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71411-4060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-476-3999
-----------------------------------------------------
Fax | 318-476-3699
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3194 HIGHWAY 71
-----------------------------------------------------
City | CAMPTI
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 71411-4060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 318-476-3999
-----------------------------------------------------
Fax | 318-476-3699
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP06853
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------