Provider Demographics
NPI:1326630260
Name:JOHNSON, DANETTE KELEMEN (APRN-CNP)
Entity Type:Individual
Prefix:MRS
First Name:DANETTE
Middle Name:KELEMEN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 ARDENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-7646
Mailing Address - Country:US
Mailing Address - Phone:337-274-4552
Mailing Address - Fax:
Practice Address - Street 1:520 N LEWIS ST FL 2
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2094
Practice Address - Country:US
Practice Address - Phone:337-374-7587
Practice Address - Fax:337-374-7578
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA218051363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner