Provider Demographics
NPI:1629579107
Name:JOHNSON, ABIGAIL SPEIGHTS (APRN-PMHNP)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:SPEIGHTS
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN-PMHNP
Other - Prefix:MRS
Other - First Name:ABIGAIL
Other - Middle Name:C
Other - Last Name:SPEIGHTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-PMHNP
Mailing Address - Street 1:1006 HIGHLAND AVE
Mailing Address - Street 2:24
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101
Mailing Address - Country:US
Mailing Address - Phone:318-678-7500
Mailing Address - Fax:
Practice Address - Street 1:1955 W TRUCKERS DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72704-5637
Practice Address - Country:US
Practice Address - Phone:479-316-6307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09861363LP0808X
AR120140363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health