Provider Demographics
NPI:1013520774
Name:JOHNSON-LEDET, MYISHA SANAE (FNP-C)
Entity Type:Individual
Prefix:
First Name:MYISHA
Middle Name:SANAE
Last Name:JOHNSON-LEDET
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MYISHA
Other - Middle Name:SANAE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:124 OAK COULEE DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70507-4816
Mailing Address - Country:US
Mailing Address - Phone:337-889-6098
Mailing Address - Fax:
Practice Address - Street 1:124 OAK COULEE DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70507-4816
Practice Address - Country:US
Practice Address - Phone:337-889-6098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA214076363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily