Provider Demographics
NPI:1356701585
Name:FELTON-JOHNSON, CUSSANDRA
Entity type:Individual
Prefix:
First Name:CUSSANDRA
Middle Name:
Last Name:FELTON-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 1:1217 CRAWFORD ST
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:LA
Mailing Address - Zip Code:71001-6575
Mailing Address - Country:US
Mailing Address - Phone:318-237-5784
Mailing Address - Fax:
Practice Address - Street 1:1217 CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:LA
Practice Address - Zip Code:71001
Practice Address - Country:US
Practice Address - Phone:318-237-5784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-01
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator