MEDICARE: MISS LAYNE BROUSSARD JOHNSON PA-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
1	363AM0700X	Medical Physician Assistant	A10595RX	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982631156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LAYNE BROUSSARD JOHNSON PA-C

Provider Business Mailing Address
First Line	:	10374 HIGHWAY 165 N STE B
Second Line	:
City	:	STERLINGTON
State	:	LA
Zip	:	71280-3320
Country	:	US
Telephone Number	:	318-665-4543
Fax Number	:

Provider Business Practice Location Address
First Line	:	10374 HIGHWAY 165 N STE B
Second Line	:
City	:	STERLINGTON
State	:	LA
Zip	:	71280-3320
Country	:	US
Telephone Number	:	318-665-4543
Fax Number	:

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

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	06/26/2014

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Directions to “ MISS LAYNE BROUSSARD JOHNSON PA-C” Practice Location

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