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NPI Code Detail

MEDICARE: MR. RANDALL SILVEN JOHNSTON II A-GNP-C

MEDICARE: MR. RANDALL SILVEN JOHNSTON II A-GNP-C
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
1363LA2200XAdult Health Nurse Practitioner202864LA
2363LG0600XGerontology Nurse Practitioner202864LA
3363LP2300XPrimary Care Nurse Practitioner202864LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AG05220099OTHERAMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION BOARD
2202864OTHERLALOUISIANA STATE BOARD OF NURSING

General Provider Information

NPI Number : 1891420931
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RANDALL SILVEN JOHNSTON II A-GNP-C
Provider Business Mailing Address
First Line : 1333 COATES BLUFF DR APT 1525
Second Line :
City : SHREVEPORT
State : LA
Zip : 71104-2800
Country : US
Telephone Number : 318-229-8539
Fax Number :
Provider Business Practice Location Address
First Line : 2890 DOUGLAS DR # 100
Second Line :
City : BOSSIER CITY
State : LA
Zip : 71111-5806
Country : US
Telephone Number : 318-742-6900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2022
Last Update Date : 09/15/2022

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