MEDICARE: MEREDITH V JOHNSON N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	29873	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00376229	OTHER	LA	METRAHEALTH RR
2	P00373288	OTHER	LA	METRAHEALTH RR
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083640908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEREDITH V JOHNSON N.P.

Provider Business Mailing Address
First Line	:	PO BOX 395
Second Line	:
City	:	CLINTON
State	:	LA
Zip	:	70722-0395
Country	:	US
Telephone Number	:	225-683-5292
Fax Number	:	225-683-3411

Provider Business Practice Location Address
First Line	:	751 COURT ST
Second Line	:
City	:	PORT ALLEN
State	:	LA
Zip	:	70767-2635
Country	:	US
Telephone Number	:	225-389-1311
Fax Number	:	225-389-1330

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	05/22/2012

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