Provider Demographics
NPI:1083640908
Name:JOHNSON, MEREDITH V (NP)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:V
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 395
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70722-0395
Mailing Address - Country:US
Mailing Address - Phone:225-683-5292
Mailing Address - Fax:225-683-3411
Practice Address - Street 1:751 COURT ST
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767-2635
Practice Address - Country:US
Practice Address - Phone:225-389-1311
Practice Address - Fax:225-389-1330
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA29873363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00376229OtherMETRAHEALTH RR
LAP00373288OtherMETRAHEALTH RR
LA1183075Medicaid
LA4H721Medicare ID - Type Unspecified
LA3B194CH71Medicare PIN
LA1183075Medicaid
LAP00376229OtherMETRAHEALTH RR
LA4H721CH88Medicare ID - Type Unspecified