Provider Demographics
NPI:1710460597
Name:JOHNSON, ASHLEY (CPM LM)
Entity Type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CPM LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1506 RUE MIRAMON
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-2224
Mailing Address - Country:US
Mailing Address - Phone:318-680-9443
Mailing Address - Fax:504-285-4100
Practice Address - Street 1:1506 RUE MIRAMON
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-2224
Practice Address - Country:US
Practice Address - Phone:318-680-9443
Practice Address - Fax:504-285-4100
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA310751176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife