Provider Demographics
NPI:1942928296
Name:JOHNSON, KEIRYANNA JANEL
Entity Type:Individual
Prefix:
First Name:KEIRYANNA
Middle Name:JANEL
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 1:1035 CALHOUN ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70118-5913
Mailing Address - Country:US
Mailing Address - Phone:504-308-3501
Mailing Address - Fax:504-301-0835
Practice Address - Street 1:1035 CALHOUN ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118-5913
Practice Address - Country:US
Practice Address - Phone:504-308-3501
Practice Address - Fax:504-301-0835
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician