Provider Demographics
NPI:1992393748
Name:JOHNSON, KAREN (RN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
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:PO BOX 1480
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:LA
Mailing Address - Zip Code:70711-1480
Mailing Address - Country:US
Mailing Address - Phone:985-634-2370
Mailing Address - Fax:
Practice Address - Street 1:31044 N CAFELINE RD
Practice Address - Street 2:
Practice Address - City:TICKFAW
Practice Address - State:LA
Practice Address - Zip Code:70466-4006
Practice Address - Country:US
Practice Address - Phone:985-634-2370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN118032163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice