Provider Demographics
NPI:1811528789
Name:JOHNSON, CELESTA B (FNP)
Entity type:Individual
Prefix:
First Name:CELESTA
Middle Name:B
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CELESTA
Other - Middle Name:ANN
Other - Last Name:BERTRAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:218 HECTOR CONNOLY RD
Mailing Address - Street 2:STE. 200
Mailing Address - City:CARENCRO
Mailing Address - State:LA
Mailing Address - Zip Code:70520
Mailing Address - Country:US
Mailing Address - Phone:337-886-8763
Mailing Address - Fax:
Practice Address - Street 1:218 HECTOR CONNOLY RD
Practice Address - Street 2:STE. 200
Practice Address - City:CARENCRO
Practice Address - State:LA
Practice Address - Zip Code:70520
Practice Address - Country:US
Practice Address - Phone:337-886-8763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-30
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA211520363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily