Provider Demographics
NPI:1619688637
Name:JOHNSON, SHEMEELA GAIL
Entity Type:Individual
Prefix:
First Name:SHEMEELA
Middle Name:GAIL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8040 STONESHIRE DR
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70818-5762
Mailing Address - Country:US
Mailing Address - Phone:225-223-0365
Mailing Address - Fax:
Practice Address - Street 1:7485 OAKLEAF DR
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70812-3728
Practice Address - Country:US
Practice Address - Phone:225-930-5056
Practice Address - Fax:225-930-5162
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN141382163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult