Individual
KASSIDY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17000 MEDICAL CENTER DR, BATON ROUGE, LA 70816-3246
(225) 755-4858
Mailing address
29219 HORSESHOE RD, INDEPENDENCE, LA 70443-3557
(985) 606-0279
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AP09181
LA
363LG0600X
Gerontology Nurse Practitioner
AP09181
LA
Other
Enumeration date
01/13/2017
Last updated
02/28/2017
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