Provider Demographics
NPI:1801336706
Name:JOHNSON, DIA M (APRN, WHNP-BC, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:DIA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:APRN, WHNP-BC, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 FAIRFIELD AVE STE 569
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4331
Mailing Address - Country:US
Mailing Address - Phone:318-676-7489
Mailing Address - Fax:
Practice Address - Street 1:1525 FAIRFIELD AVE STE 569
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4331
Practice Address - Country:US
Practice Address - Phone:318-676-7489
Practice Address - Fax:318-676-7560
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07939363LF0000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily