Provider Demographics
NPI:1972292837
Name:JOHNSON, SKI LYNN (RN)
Entity Type:Individual
Prefix:
First Name:SKI
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 PORTSMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70460-8443
Mailing Address - Country:US
Mailing Address - Phone:760-628-9774
Mailing Address - Fax:
Practice Address - Street 1:515 PORTSMOUTH DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70460-8443
Practice Address - Country:US
Practice Address - Phone:760-628-9774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 171400000X, 174H00000X, 175F00000X
CA95116161163W00000X
OR202210315RN163W00000X
LA155850163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator
No175F00000XOther Service ProvidersNaturopath