MEDICARE: MRS. KRISTEN JOHNSON FNP

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	363LF0000X	Family Nurse Practitioner	AP05806	LA

General Provider Information

NPI Number	:	1225266067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KRISTEN JOHNSON FNP

Provider Business Mailing Address
First Line	:	PO BOX 2780
Second Line	:
City	:	JENA
State	:	LA
Zip	:	71342-2780
Country	:	US
Telephone Number	:	318-992-6311
Fax Number	:

Provider Business Practice Location Address
First Line	:	180 NINTH ST
Second Line	:
City	:	JENA
State	:	LA
Zip	:	71342-3900
Country	:	US
Telephone Number	:	318-992-6311
Fax Number	:

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

Provider Enumeration Date	:	07/01/2009
Last Update Date	:	12/08/2016

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